Donor lung preservation strategies: Ice vs pEVLP vs CHS

Results from a single-center, retrospective study evaluating standard ice-based preservation (n = 282) vs portable ex vivo lung perfusion (pEVLP; n = 139) vs controlled hypothermic storage (CHS; n = 76) in adults undergoing lung transplantation were recently published in The Annals of Thoracic Surgery by Karla et al. The primary outcome was Grade 3 primary graft dysfunction (PGD3) at 48–72 hours.  

Key data: PGD3 at 48–72 hours occurred at similar rates with pEVLP (31.7%), CHS (34.2%), and ice (29.4%; p = 0.70). A higher incidence of postoperative extracorporeal membrane oxygenation (ECMO) use was observed with pEVLP (26.1%) and CHS (30.7%) vs ice (15.6%; p = 0.003). Mechanical ventilation use >48 hours was also more common with pEVLP (71.7%) and CHS (77.6%) vs ice (54.5%; p < 0.001). However, in multivariable analysis, the preservation strategy was not independently associated with PGD3, postoperative ECMO use, or mechanical ventilation >48 hours. Among extended-criteria donor (ECD) lung recipients, there were no differences between pEVLP and CHS in PGD3, postoperative ECMO use, duration of ventilator support, postoperative dialysis, or 90-day survival. 

Key learning: pEVLP and CHS demonstrated similar outcomes to ice-based preservation in lung transplant recipients, despite longer preservation times, supporting their use as strategies to expand the donor pool and enable extended preservation times