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Lung transplantation after ex vivo lung perfusion in two Scandinavian centres.

Journal article
Authors Tobias Nilsson
Andreas Wallinder
Ian Henriksen
Jens Christian Nilsson
Sven-Erik Ricksten
Hasse Møller-Sørensen
Gerdt C Riise
Michael Perch
Göran Dellgren
Published in European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
Volume 55
Pages 766-772
ISSN 1873-734X
Publication year 2019
Published at
Pages 766-772
Language en
Links dx.doi.org/10.1093/ejcts/ezy354
www.ncbi.nlm.nih.gov/entrez/query.f...
Subject categories Surgery

Abstract

We reviewed our combined clinical outcome in patients who underwent lung transplantation after ex vivo lung perfusion (EVLP) and compared it to the contemporary control group.At 2 Scandinavian centres, lungs from brain-dead donors, not accepted for donation but with potential for improvement, were subjected to EVLP (n = 61) and were transplanted if predefined criteria were met. Transplantation outcome was compared with that of the contemporary control group consisting of patients (n = 271) who were transplanted with conventional donor lungs.Fifty-four recipients from the regular waiting list underwent transplantation with lungs subjected to EVLP (1 bilateral lobar, 7 single and 46 double). In the EVLP and control groups, arterial oxygen tension/inspired oxygen fraction ratio at arrival in the intensive care unit (ICU) was 30 ± 14 kPa compared to 36 ± 14 (P = 0.005); median time to extubation was 18 h (range 2-912) compared to 7 (range 0-2280) (P = 0.002); median ICU length of stay was 4 days (range 2-65) compared to 3 days (range 1-156) (P = 0.002); Percentage of expected forced expiratory volume at 1s (FEV1.0%) at 1 year was 75 ± 29 compared to 81 ± 26 (P = 0.18); and the 1-year survival rate was 87% [confidence interval (CI) 82-92%] compared to 83% (CI 81-85), respectively. Follow-up to a maximum of 5 years did not show any significant difference in survival between groups (log rank, P = 0.63).Patients transplanted with lungs after EVLP showed outcomes comparable to patients who received conventional organs at medium-term follow-up. Although early outcome immediately after transplantation showed worse lung function in the EVLP group, no differences were observed at a later stage, and we consider EVLP to be a safe method for increasing the number of transplantable organs.

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