Abstract：
The decision to perform a single-lung transplant (SLT) when the contralateral donor lung is rejected is a challenging scenario. The introduction of ex vivo lung perfusion (EVLP) has improved donor lung assessment, and we hypothesize that it has improved SLT outcomes in this setting.
A retrospective single-center review of all SLTs performed between 2000 and 2017 was performed in which the years 2000 to 2008 were considered the \"pre-EVLP era\" and 2009 to 2017 the \"EVLP era.\" Recipients of SLT lungs when the contralateral lung was declined were classified into 3 groups: (1) Pre-EVLP era, (2a) EVLP era but EVLP not used, and (2b) EVLP era and EVLP used. The outcomes of interest were survival, time-to-extubation, and intensive care unit and hospital stay.
Among 1692 transplants between 2000 and 2017, 244 (14%) were SLT. SLT rate was similar between eras (pre-EVLP 16% vs EVLP 15%), but more SLTs were performed where the contralateral lung was declined in the EVLP era (pre-EVLP 32% vs EVLP 45%, P = .04). Lungs evaluated on EVLP had lower procurement partial pressure of oxygen and were more often from donation after cardiac death donors. Recipients were generally also sicker, with a greater proportion of rapidly deteriorating recipients. Despite this, outcomes were similar between eras with a trend towards lower 30-day mortality in the EVLP era.
The availability of EVLP allowed for better evaluation of marginal single lungs when the contralateral was declined. This has led to increased use rates with preserved outcomes despite use of more extended criteria organs.
A retrospective single-center review of all SLTs performed between 2000 and 2017 was performed in which the years 2000 to 2008 were considered the \"pre-EVLP era\" and 2009 to 2017 the \"EVLP era.\" Recipients of SLT lungs when the contralateral lung was declined were classified into 3 groups: (1) Pre-EVLP era, (2a) EVLP era but EVLP not used, and (2b) EVLP era and EVLP used. The outcomes of interest were survival, time-to-extubation, and intensive care unit and hospital stay.
Among 1692 transplants between 2000 and 2017, 244 (14%) were SLT. SLT rate was similar between eras (pre-EVLP 16% vs EVLP 15%), but more SLTs were performed where the contralateral lung was declined in the EVLP era (pre-EVLP 32% vs EVLP 45%, P = .04). Lungs evaluated on EVLP had lower procurement partial pressure of oxygen and were more often from donation after cardiac death donors. Recipients were generally also sicker, with a greater proportion of rapidly deteriorating recipients. Despite this, outcomes were similar between eras with a trend towards lower 30-day mortality in the EVLP era.
The availability of EVLP allowed for better evaluation of marginal single lungs when the contralateral was declined. This has led to increased use rates with preserved outcomes despite use of more extended criteria organs.
摘要：
目的：当对侧供体肺被排斥时进行单肺移植（SLT）的决定是一个具有挑战性的情况。离体肺灌注（EVLP）的引入改善了供体肺评估，我们假设它在这种情况下改善了SLT结果。
方法：对2000年至2017年进行的所有SLT进行了回顾性单中心回顾，其中2000年至2008年被认为是“前EVLP时代”，2009年至2017年被认为是“EVLP时代”。“对侧肺下降时SLT肺的接受者分为3组：（1）前EVLP时代，(2a)EVLP时代，但未使用EVLP，和(2b)EVLP时代和使用的EVLP。感兴趣的结果是生存，拔管时间,重症监护室和住院。
结果：在2000年至2017年的1692例移植中，244例（14％）为SLT。不同时期的SLT率相似(EVLP前16%对EVLP15%)，但是在EVLP时代，对侧肺下降的情况下进行了更多的SLT（前EVLP为32％vsEVLP为45％，P=.04）。在EVLP上评估的肺具有较低的氧气获取分压，并且更多来自心脏死亡捐赠者后的捐赠。收件人通常也病重，迅速恶化的接受者比例更高。尽管如此,不同时代的结局相似,EVLP时代的30日死亡率有降低趋势.
结论：EVLP的可用性允许对侧减少时更好地评估边缘单肺。尽管使用了更多扩展的标准器官，但这导致了使用率的增加，并保留了结果。
方法：对2000年至2017年进行的所有SLT进行了回顾性单中心回顾，其中2000年至2008年被认为是“前EVLP时代”，2009年至2017年被认为是“EVLP时代”。“对侧肺下降时SLT肺的接受者分为3组：（1）前EVLP时代，(2a)EVLP时代，但未使用EVLP，和(2b)EVLP时代和使用的EVLP。感兴趣的结果是生存，拔管时间,重症监护室和住院。
结果：在2000年至2017年的1692例移植中，244例（14％）为SLT。不同时期的SLT率相似(EVLP前16%对EVLP15%)，但是在EVLP时代，对侧肺下降的情况下进行了更多的SLT（前EVLP为32％vsEVLP为45％，P=.04）。在EVLP上评估的肺具有较低的氧气获取分压，并且更多来自心脏死亡捐赠者后的捐赠。收件人通常也病重，迅速恶化的接受者比例更高。尽管如此,不同时代的结局相似,EVLP时代的30日死亡率有降低趋势.
结论：EVLP的可用性允许对侧减少时更好地评估边缘单肺。尽管使用了更多扩展的标准器官，但这导致了使用率的增加，并保留了结果。
