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Invited Commentary
October 9, 2019

Expanding the Lung Donor Pool and Improving Outcomes: Ex Vivo Lung Perfusion

Author Affiliations
  • 1Division of Thoracic Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
  • 2Division of Pulmonary and Critical Care Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
JAMA Surg. Published online October 9, 2019. doi:10.1001/jamasurg.2019.4080

Limited donor lung availability and prolonged wait times remain substantial barriers to lung transplant. According to the Scientific Registry of Transplant Recipients, 11% of patients were removed from the wait-list in 2017 because of death or clinical deterioration and 40% of patients waited longer than 1 year before transplant.1 Ex vivo lung perfusion (EVLP) provides the opportunity to expand the donor pool, but despite encouraging early posttransplant outcomes,2,3 the long-term effect of EVLP remains unclear. In this issue of JAMA Surgery, Divithotawela et al4 present 10-year outcomes of the Toronto Lung Transplant Group’s experience with normothermic EVLP for lungs from extended-criteria donors and donation after cardiac death. They report that despite being obtained from potentially higher-risk donors, the EVLP donor lungs demonstrated equivalent rates of chronic lung allograft dysfunction and allograft survival at 10-year follow-up. Additionally, at their center, EVLP was associated with a significant increase in the number of transplants during the study period. While there were inherent limitations, such as the retrospective nature of the study, debatable higher-risk status of EVLP lungs, nonrandom assignment of EVLP, and a lack of confounder-adjusted comparison, this study suggests that satisfactory long-term outcomes can be accomplished with EVLP, a valuable contribution. Notably, the system used in this study differs from the commercially available US Food and Drug Administration–approved system in its atrial drainage (closed vs open), and the data presented in this study may not apply to that system.5

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