The Evolving Role of Ex Vivo Lung Perfusion during the COVID-19 Pandemic

PURPOSE: The novel coronavirus (COVID-19) pandemic presented unique challenges to lung transplant (LTx) programs. On the donor side, infection concerns resulted in a dramatic reduction in donor lung offers and raised the specter of viral transmission to procurement team members. On the recipient side, the need for pre-transplant COVID-19 testing and COVID free patient care units presented unprecedented logistical challenges. New indications for ex vivo lung perfusion (EVLP) also emerged, including logistics (e.g. providing adequate time for recipient COVID testing), and donor lung evaluation following 3(rd) party procurement. In this study, we defined the novel roles of EVLP that our LTx program developed during the COVI-19 pandemic. METHODS: Retrospective analysis of adult LTx procedures performed at our institute from March 17(th) (when COVID restrictions began at our institute) through May 31(st) 2020, compared to LTx performed during the same period in 2019. RESULTS: During the study period, 17 LTx were performed. Eight of 17 were performed after EVLP evaluation, and 6 with EVLP back-up. Notably, the number of LTx after EVLP doubled vs. the same period in 2019, and the number of LTx cases with EVLP backup tripled (Figure 1A). Indications for EVLP in 4 LTx cases and 4 cases with EVLP backup were unique to pandemic conditions (Figure 1B). To date, no patients transplanted during this period, or team members tested positive for COVID-19, or are suspected of COVID infection post-LTx. 30-day survival was 100%, and incidence of primary graft dysfunction grades 0, 1, 2, and 3 at 72 hours post-transplant were 39%, 52%, 4%, and 4%, respectively. Median ventilation duration was 1 day. CONCLUSION: Maintaining LTx activity with EVLP was feasible in the early phases of the COVID-19 pandemic. EVLP enabled our team to solve challenges with donor evaluation and logistics. By enabling donor assessment after local procurement, EVLP also increased the procurement team's safety. In the future, these newer EVLP indications may be applicable beyond the COVID-19 pandemic.