• Ernest G Chan, Rachel L Deitz, Jack K Donohue, John P Ryan, Yota Suzuki, Masashi Furukawa, Kentaro Noda, and Pablo G Sanchez.
• Section of Thoracic Surgery, Department of Surgery, University of Chicago Medicine, Chicago, Ill. Electronic address: Ernest.Chan@bsd.uchicago.edu.
• J. Thorac. Cardiovasc. Surg. 2024 Nov 1.

PurposeWe report outcomes associated with ex vivo lung perfusion (EVLP) lungs in high-risk lung transplant recipients utilizing a national database.MethodsWe performed a retrospective analysis of the United Network for Organ Sharing Database (January 1, 2018-March 31, 2024). High-risk status was defined as mean pulmonary arterial pressure >35 mm Hg, lung retransplantation, or bridge to transplant. In addition to univariable analysis, propensity-score matched analysis was performed on predictors of donor and recipient characteristics.ResultsRisk of dying on the waitlist was significantly higher for high-risk candidates (hazard ratio, 1.69; 95% CI, 1.51-1.89; P < .001). Following matching, 203 EVLP cases were matched to 609 standard procurement recipients. The EVLP group was associated with higher rates of postoperative acute kidney injury requiring renal replacement therapy (27% vs 16%; P < .001), higher mortality on index admission (13% vs 8%; P = .04), and longer length of stay (29 vs 25 days; P = .006). EVLP modality was associated with survival time (P < .001) with portable EVLP having significantly shorter survival (2.7 years) relative to standard cases (4.7 years; P < .02). A subgroup analysis found that this survival effect was limited to bridge and retransplant recipients.ConclusionsEVLP lungs were associated with higher rates of postoperative acute kidney injury and portable EVLP was associated with shorter survival in high-risk lung transplant recipients. However, given the high waitlist mortality in this candidate population, EVLP lungs should still be considered an alternative.Copyright © 2024 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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