The Clinical Significance of Donor Lung Weight at Procurement and during Ex Vivo Lung Perfusion

Purpose Elevated donor lung weight can result from excess extravascular lung water and adversely affect transplant suitability and post-transplant outcomes. We sought to define the impact of lung weight on 1) donor lung suitability and 2) post-transplant graft dysfunction in lungs transplanted with and without ex vivo lung perfusion (EVLP). Methods From Feb 2016 to Aug 2020, 365 human lung donors were reviewed. Of 365, 239 were transplanted without EVLP, 74 treated with acellular EVLP (50 went on to transplant), and 52 declined for transplant without EVLP. Lung weights were measured at two time points: at 0 hr (LW0; after lung explant or start of EVLP), and after EVLP was completed (LWend). LW0 data were divided into 4 quartiles (Category 1=0-25%, Category 2=25-50%, Category 3=50-75%, and Category 4=75-100%) within 3 height groups ( Results For LW0 Category 4, EVLP was utilized more frequently (45 vs. 17%, p Conclusion Donor lungs in the highest quartile of lung weight are associated with increased need for EVLP, but lower transplant suitability rates after EVLP when compared to lungs with lower weight. Donor lungs in the highest quartile are also associated with higher Grade 3 PGD rates and longer ICU/hospital stay. These findings should be taken into account when high weight donor lungs are considered for clinical use.