Extended post-ex vivo lung perfusion cold preservation predicts primary graft dysfunction and mortality: Results from a multicentric study.

ABSTRACT Purpose EVLP allows for reassessment of lung grafts initially deemed unsuitable for transplantation, increasing the available donor pool, however this requires a pre and post-EVLP period of cold ischemic time (CIT). Paucity of data exist on how the sequence of cold-normothermic-cold preservations affect outcomes. Methods A total of 110 patients were retrospectively analyzed. Duration of the 3 preservation phases was measured: cold pre EVLP; EVLP; cold post EVLP. Donor and recipient clinical data were collected. Primary graft dysfunction (PGD) and survival were monitored. Risk of mortality or PGD were calculated using Cox-proportional hazards and logistic regression models to adjust for baseline characteristics. Results Using the highest quartile, patients were stratified into extended vs non-extended pre ( Conclusions Extended cold post EVLP preservation is associated with risk for PGD and 1-year mortality. Pre-EVLP CIT does not increase mortality or high grade PGD. These findings from a multicenter trial should caution on the implementation of extended cold preservation post EVLP.