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Updated: Aug 5, 2026
Establishment of a Novel Ex Vivo Lung Perfusion System for Rat Lungs After Circulatory Death
Published on: October 18, 2024
A Comparison of Contemporary Donor Lung Preservation Strategies: Ice vs Portable Ex Vivo Lung Perfusion vs Controlled
Anirudha Karla1, Reginald Chounoune1, Anh Nguyen1
1Division of Cardiothoracic Transplantation, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
Background:
Advanced donor lung preservation strategies, such as portable ex vivo lung perfusion (pEVLP) and controlled hypothermic storage (CHS) at 4 to 8 °C, have revolutionized the practice of lung transplantation, allowing for prolonged preservation and expansion of the donor pool compared with ice. However, how to integrate different strategies in the modern era, especially the role of pEVLP vs CHS, remains unclear.
Methods:
We reviewed all adult lung transplants performed at our institution from January 2016 to January 2025, excluding multiorgan transplants. Patients were grouped by preservation method: ice (n = 282), pEVLP (n = 139), or CHS (n = 76). We compared perioperative outcomes across the 3 strategies. Subanalyses were performed comparing pEVLP vs CHS in cases of extended criteria donor lungs and prolonged preservation times (out-of-body time >8 hours).
Results:
The pEVLP and CHS groups had higher-risk recipient and donor characteristics compared with ice. There was no difference in primary graft dysfunction grade 3 at 48 to 72 hours among groups, but there was a higher incidence of postoperative extracorporeal membrane oxygenation and prolonged ventilator support in the pEVLP and CHS groups. However, in multivariable logistic regression, preservation strategy was not associated with allograft graft dysfunction, despite significantly longer preservation times.
Conclusions:
Overall, pEVLP and CHS achieved outcomes similar to ice, despite significantly longer preservation times. Accordingly, pEVLP and CHS both represent viable strategies to expand the donor pool and enable extended preservation times.
