National utilization, trends, and lung transplant outcomes of static vs. portable ex vivo lung perfusion platforms.

BACKGROUND: This study compared utilization and outcomes of the two widely utilized ex vivo lung perfusion (EVLP) platforms in the United States (US): a static platform and a portable platform.

METHODS: Adult (≥18 years) bilateral lung-only transplants utilizing EVLP between 2/28/2018-12/31/2022 in the United Network for Organ Sharing database were included. Pre-discharge acute rejection, intubation at 72 hours post-transplant, extracorporeal membrane oxygenation (ECMO) at 72 hours post-transplant, primary graft dysfunction grade 3 (PGD3) at 72 hours post-transplant, 30-day mortality, and 1-year mortality were evaluated using multivariable regressions.

RESULTS: Overall, 607 (6.3%) of lung transplants during the study period used EVLP (51.2% static, 48.8% portable). Static EVLP was primarily utilized in the eastern US, whereas portable EVLP was primarily utilized in the western US. Static EVLP donors were more likely to be DCD (33.4% vs. 26.0%, p=0.005), have a >20 pack-year smoking history (13.5% vs. 6.5%, p=0.005), and be extended criteria donors (92.3% vs. 85.0%, p=0.013), while portable EVLP donors were more likely to be >55 years of age (14.2% vs. 8.0%, p=0.02). Transplants utilizing the static and portable platforms had similar risk of acute rejection, intubation at 72 hours, ECMO at 72 hours, PGD3 at 72 hours, and post-transplant mortality at 30 days and 1 year (all p>0.05).

CONCLUSIONS: The static and portable platforms had significant differences in donor characteristics and geographic distributions of utilization. Despite this, post-transplant survival was similar between the two EVLP platforms.