Increasing Use of EVLP in the United States: Data from the OPTN/UNOS

Purpose The OPTN/UNOS added fields to the deceased donor registration form on 3/31/2015 and the transplants recipient registration (TRR) form on 2/28/2018 to collect data on the utilization of ex vivo lung perfusion (EVLP) on donor lung. The steadily increasing use of EVLP, early outcomes, and new data collected on the TRR are summarized. Methods To determine trends in the use of EVLP, all deceased donor lungs recovered from 4/1/2015- 6/30/2018 were analyzed and divided into an EVLP and non-EVLP cohort. TRR data was available for recipients receiving a transplant between 2/28/2018- 6/30/2018. One year lung recipient survival was compared for the cohort spanning 4/1/2015- 6/30/2017. Results EVLP was utilized on 447 of 14,269 recovered lungs procured from 7,524 deceased donors. Of the 447 with EVLP utilized, 165 (34.6%) were DCD donors and 270 (56.6%) were transplanted. A total of 49 out of 58 (84%) OPOs perfused at least 1 lung. By examining the use of EVLP by annual quarters, the earliest quarter had 16 lungs perfused (1.7%) while the most recent quarter had 70 lungs perfused (5.8%). The discard rate for EVLP lungs was statistically higher than lungs that were not perfused (43.4% vs. 4.4%, p < 0.001) and one year recipient survival was not statistically different between groups (EVLP 86.5%; non-EVLP 89.2%, p=0.165). TRR data revealed that the majority of lungs are perfused at the recovery site (61.7%) and most perfusion was done by the transplant program (55.0%). Conclusion Since April 2015, the use of EVLP has increased to the current reported level of almost 6% of deceased donor lungs recovered for transplant in the US. The majority of EVLP lungs are perfused at the recovery site by transplant programs and there is no evidence of a negative impact on one year recipient survival. Continued data collection on donor lung perfusion on both the DDR and TRR will allow the OPTN to better understand the utilization of this evolving technology. The OPTN/UNOS added fields to the deceased donor registration form on 3/31/2015 and the transplants recipient registration (TRR) form on 2/28/2018 to collect data on the utilization of ex vivo lung perfusion (EVLP) on donor lung. The steadily increasing use of EVLP, early outcomes, and new data collected on the TRR are summarized. To determine trends in the use of EVLP, all deceased donor lungs recovered from 4/1/2015- 6/30/2018 were analyzed and divided into an EVLP and non-EVLP cohort. TRR data was available for recipients receiving a transplant between 2/28/2018- 6/30/2018. One year lung recipient survival was compared for the cohort spanning 4/1/2015- 6/30/2017. EVLP was utilized on 447 of 14,269 recovered lungs procured from 7,524 deceased donors. Of the 447 with EVLP utilized, 165 (34.6%) were DCD donors and 270 (56.6%) were transplanted. A total of 49 out of 58 (84%) OPOs perfused at least 1 lung. By examining the use of EVLP by annual quarters, the earliest quarter had 16 lungs perfused (1.7%) while the most recent quarter had 70 lungs perfused (5.8%). The discard rate for EVLP lungs was statistically higher than lungs that were not perfused (43.4% vs. 4.4%, p < 0.001) and one year recipient survival was not statistically different between groups (EVLP 86.5%; non-EVLP 89.2%, p=0.165). TRR data revealed that the majority of lungs are perfused at the recovery site (61.7%) and most perfusion was done by the transplant program (55.0%). Since April 2015, the use of EVLP has increased to the current reported level of almost 6% of deceased donor lungs recovered for transplant in the US. The majority of EVLP lungs are perfused at the recovery site by transplant programs and there is no evidence of a negative impact on one year recipient survival. Continued data collection on donor lung perfusion on both the DDR and TRR will allow the OPTN to better understand the utilization of this evolving technology.