Extended Post EVLP Cold Preservation Increases Risk of Primary Graft Dysfunction and Mortality

PURPOSE: EVLP allows for reassessment of lung grafts initially deemed unsuitable for transplantation, increasing the available donor pool. Standard cold preservation is followed by normothermic EVLP, then lungs undergo a second cold preservation prior to implantation. Paucity of data exist on how the sequence of cold-normothermic-cold preservations affect outcomes. We investigated the effects of preservation times in transplanted EVLP lungs. METHODS: Data from the NOVEL trial (110pts) was retrospectively analyzed. Duration of the 3 preservation phases was measured: cold pre EVLP; EVLP; cold post EVLP. Donor and recipient clinical data were collected. Primary graft dysfunction (PGD) and survival were monitored. Risk of mortality or PGD were calculated using Cox-proportional hazards and logistic regression models to adjust for baseline characteristics. RESULTS: Using the highest quartile, pts were stratified in extended (>287 min, n=27) and non-extended (<287 min, n=89) cold post-EVLP time. Age, LAS, cold pre-EVLP, EVLP time, type of Tx, gender and recipient diagnosis were similar between groups. The rates of PGD ≥2-3 (20.5% vs 52%, p=0.002) and PGD 3 (8.4% vs 29.6%, p=0.005) at 72hrs post-Tx were increased in the extended group. The 1-year survival was lower for patients with extended cold post-EVLP (91.6% vs 70.4%, p=0.013) as was 3-year survival (75.9% vs 55.6%, p=0.023). After adjusting for age, LAS, diagnosis, cold pre-EVLP, donor smoking history, donor last PaO2, and type of Tx, the extended group remained an independent predictor of PGD ≥2-3 (OR: 6.35, 95% CI: 1.98-19.73, P=0.002) and PGD 3 (OR: 10.47, 95% CI: 2.2-49.9, P=0.003) at 72 hrs and of 1-year mortality (HR: 10, 95% CI2.35-39.9, P=0.001). Cold Pre-EVLP and EVLP time were not significant predictors of outcomes. CONCLUSION: Extended cold post EVLP preservation (5 hrs or more) associated with risk for PGD and 1-year mortality. These findings from a multicenter trial should caution on the implementation of extended cold preservation post EVLP.

Duke Scholars

Author Matthew Hartwig Surgery, Cardiovascular and Thoracic Surgery