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Lung transplantation after ex vivo lung perfusion in two Scandinavian centres

OBJECTIVES: 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. METHODS: At 2 Scandinavian centres, lungs from brain-dead donors, not accepted for donation but with potential f...

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Detalles Bibliográficos
Autores principales: Nilsson, Tobias, Wallinder, Andreas, Henriksen, Ian, Nilsson, Jens Christian, Ricksten, Sven-Erik, Møller-Sørensen, Hasse, Riise, Gerdt C, Perch, Michael, Dellgren, Göran
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6421510/
https://www.ncbi.nlm.nih.gov/pubmed/30376058
http://dx.doi.org/10.1093/ejcts/ezy354
Descripción
Sumario:OBJECTIVES: 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. METHODS: 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. RESULTS: 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 (FEV(1.0)%) 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). CONCLUSIONS: 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.