The following is a summary of the “Ex vivo lung evaluation of single donor lungs when the contralateral lung is rejected increases safe use,” published in the February 2023 issue of Thoracic and cardiovascular surgery by Dunne, et al.

When the opposite donor lung is rejected, deciding to undertake a single-lung transplant (SLT) is difficult. They propose that including ex vivo lung perfusion (EVLP) has improved SLT outcomes because it has enhanced donor lung evaluation.

There was a single-center retrospective analysis of all SLTs from 2000-2017; 2000-2008 were labeled as the “pre-EVLP era,” while 2009-2017 were labeled as the “EVLP era.” Lung transplant recipients who had the contralateral lung declined were divided into three groups: those who received their transplant before EVLP, those who received their transplant during the EVLP era but did not receive EVLP, and those who received their transplant during the EVLP era, and did receive EVLP. Survival, time-to-extubation, and length of ICU and hospital stay were the outcomes of interest.

Between 2000-2017, there were 1,692 transplants performed, of which 244 (14%) were SLT. The rate of SLT was comparable in the two time periods (16% pre-EVLP and 15% post-EVLP), but more SLTs were conducted in the EVLP era in which the contralateral lung had decreased (32% pre-EVLP and 45% post-EVLP, P =.04). The partial procurement pressure of oxygen was lower in EVLP-evaluated lungs, and these lungs were more often obtained from donors whose hearts had stopped beating before donation. 

The beneficiaries were sicker on average, with a higher percentage experiencing a fast decline. Nonetheless, the outcomes were comparable between the eras, with a trend towards lower 30-day mortality in the EVLP era. When the contralateral lung was rejected, the availability of EVLP allowed for a more accurate assessment of the remaining lung. As a result, adoption rates have risen while outcomes have remained stable, even as the criteria for eligibility have broadened.

Source: sciencedirect.com/science/article/abs/pii/S0022522322003476