Ex Vivo Lung Perfusion in Donation after Circulatory Death: A Post-Hoc Analysis of the NOVEL Trial

Objective Donation after circulatory death (DCD) donors offer the ability to expand the lung donor pool and ex vivo lung perfusion (EVLP) further contributes to this ability by allowing for additional evaluation and resuscitation of these extended criteria donors. We sought to determine the outcomes of recipients receiving organs from DCD EVLP donors in a multi-center setting. Methods This was an unplanned post-hoc analysis of a multicenter, prospective, non-randomized trial that took place in 2011-2017 with 3-years of follow up. Patients were placed into three groups based off procurement strategy: brain-dead donor (BDD) (Control), BDD evaluated by EVLP and DCD donors evaluated by EVLP. The primary outcomes were severe primary graft dysfunction (PGD3) at 72 hours and survival. Secondary outcomes included select peri-operative outcomes, and 1-year and 3-years allograft function and quality of life measures. Results The DCD EVLP group had significantly higher incidence of PGD3 at 72 hours (p=0.03), longer days on mechanical ventilation (p<0.001) and in-hospital length of stay (p=0.045). Survival at 3-years was: 76.5% (95% CI: 69.2%-84.7%) for the Control group, 68.3% (95% CI: 58.9%-79.1%) for the BDD group, and 60.7% (95% CI: 45.1%-81.8%) for the DCD group (p=0.36). At 3-year follow-up, presence observed bronchiolitis obliterans syndrome or quality of life metrics did not differ amongst the groups. Conclusion While DCD EVLP allografts might not be appropriate to transplant in every candidate recipient, the expansion of their use might afford recipients stagnant on the waitlist a viable therapy.