• Miguel M Leiva-Juárez, Andreacarola Urso, Elisabet Arango Tomás, David J Lederer, Pablo Sanchez, Bartley Griffith, DavisR DuaneRDDepartment of Cardiovascular and Thoracic Surgery, Duke University, Durham, North Carolina., Mani Daneshmand, Matthew Hartwig, Edward Cantu, Michael J Weyant, Christian Bermudez, Jonathan D'Cunha, Tiago Machuca, Thomas Wozniak, William Lynch, Hassan Nemeh, Michael Mulligan, Tae Song, Michael Jessen, Phillip C Camp, Christiano Caldeira, Bryan Whitson, Daniel Kreisel, Danny Ramzy, and Frank D'Ovidio.
• Section of General Thoracic Surgery, Lung Transplant Program, Columbia University Medical Center, New York, New York.
• J. Heart Lung Transplant. 2020 Sep 1; 39 (9): 954-961.

BackgroundEx vivo lung perfusion (EVLP) allows for a reassessment of lung grafts initially deemed unsuitable for transplantation, increasing the available donor pool; however, this requires a pre- and post-EVLP period of cold ischemic time (CIT). Paucity of data exists on how the sequence of cold normothermic-cold preservations affect outcomes.MethodsA total of 110 patients were retrospectively analyzed. Duration of 3 preservation phases was measured: cold pre-EVLP, EVLP, and cold post-EVLP. The donor and recipient clinical data were collected. Primary graft dysfunction (PGD) and survival were monitored. Risk of mortality or PGD was calculated using Cox proportional hazards and logistic regression models to adjust for baseline characteristics.ResultsUsing the highest quartile, patients were stratified into extended vs non-extended pre-EVLP (<264 vs ≥264 minutes) and post-EVLP (<287 vs ≥287 minutes) CIT. The rates of 1-year mortality (8.4% vs 29.6%, p = 0.013), PGD 2-3 (20.5% vs 52%, p = 0.002), and PGD 3 (8.4% vs 29.6%, p = 0.005) at 72 hours were increased in the extended post-EVLP CIT group. After adjusting for baseline risk factors, the extended group remained an independent predictor of PGD ≥2 (odd ratio: 6.18, 95% CI: 1.88-20.3, p = 0.003) and PGD 3 (odd ratio: 20.4, 95% CI: 2.56-161.9, p = 0.004) at 72 hours and 1-year mortality (hazard ratio: 17.9, 95% CI: 3.36-95.3, p = 0.001). Cold pre-EVLP was not a significant predictor of primary outcomes.ConclusionsExtended cold post-EVLP preservation is associated with a risk for PGD and 1-year mortality. Pre-EVLP CIT does not increase mortality or high-grade PGD. These findings from a multicenter trial should caution on the implementation of extended cold preservation after EVLP.Copyright © 2020 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

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