背景:本研究比较了美国(US)两种广泛使用的离体肺灌注(EVLP)平台的利用和结果:静态平台和便携式平台。
方法:纳入2018年2月28日至2022年12月31日在联合器官共享网络数据库中使用EVLP的成人(≥18岁)双侧肺移植。出院前急性排斥反应,移植后72小时插管,移植后72小时的体外膜氧合(ECMO),移植后72小时原发性移植物功能障碍3级(PGD3),30天死亡率,和1年死亡率使用多变量回归进行评估.
结果:总体而言,在研究期间,有607例(6.3%)的肺移植使用了EVLP(51.2%静态,48.8%便携式)。静态EVLP主要在美国东部使用,而便携式EVLP主要在美国西部使用。静态EVLP供体更有可能是DCD(33.4%vs.26.0%,p=0.005),有超过20包年的吸烟史(13.5%vs.6.5%,p=0.005),并被延长标准捐赠者(92.3%vs.85.0%,p=0.013),而便携式EVLP捐赠者更有可能年龄>55岁(14.2%vs.8.0%,p=0.02)。使用静态和便携式平台的移植有类似的急性排斥风险,72小时插管,ECMO在72小时,PGD3在72小时,和移植后30天和1年的死亡率(均p>0.05)。
结论:静态和便携式平台在供体特征和利用的地理分布方面具有显著差异。尽管如此,两种EVLP平台的移植后存活率相似.
BACKGROUND: This study compared utilization and outcomes of the 2 widely utilized ex vivo lung perfusion (
EVLP) platforms in the United States: a static platform and a portable platform.
METHODS: Adult (age 18 years or older) bilateral lung-only transplants utilizing
EVLP between February 28, 2018, and December 31, 2022, in the United Network for Organ Sharing database were included. Predischarge acute rejection, intubation at 72 hours posttransplant, extracorporeal membrane oxygenation at 72 hours posttransplant, primary graft dysfunction grade 3 at 72 hours posttransplant, 30-day mortality, and 1-year mortality were evaluated using multivariable regressions.
RESULTS: Overall, 607 (6.3%) lung transplants during the study period used EVLP (51.2% static, 48.8% portable). Static
EVLP was primarily utilized in the eastern United States, whereas portable
EVLP was primarily utilized in the western United States. Static
EVLP donors were more likely to be donation after circulatory death (33.4% vs 26.0%; P = .005), have a >20 pack-year smoking history (13.5% vs 6.5%; P = .005), and be extended criteria donors (92.3% vs 85.0%; P = .013), whereas portable EVLP donors were more likely to be older than age 55 years (14.2% vs 8.0%; P = .02). Transplants utilizing the static and portable platforms had similar risk of acute rejection, intubation at 72 hours, extracorporeal membrane oxygenation at 72 hours, primary graft dysfunction grade 3 at 72 hours, and posttransplant mortality at 30 days and 1 year (all P values > .05).
CONCLUSIONS: The static and portable platforms had significant differences in donor characteristics and geographic distributions of utilization. Despite this, posttransplant survival was similar between the 2
EVLP platforms.