Lung First vs. Liver First Sequence for Combined Lung and Liver Transplantation

s S15 Purpose: Ex vivo lung perfusion (EVLP) is being increasingly used as a method of evaluating high-risk lungs for transplantation. Previous reports comparing EVLP outcomes with standard transplantation did not match for recipient and transplant characteristics. We examined the outcomes of a large cohort of patients who received EVLP lungs with a propensity score matched conventional cohort. Methods: Patients (1/06-4/15) who received at least one EVLP lung were included in the study. Of the 958 transplants performed, 133 utilized EVLP lungs. 170 lung blocks were evaluated by EVLP during the same period. Propensity matching (1:1, nearest neighbor) was used to identify a matched cohort of 133 patients from patients receiving a conventional lung. Matching factors included age at transplant, pulmonary disease, cold ischemic time, and single vs double lung transplant. Quantile-quantile plots were used to check balance. Re-transplant, heart-lung transplant, and transplant of patients bridged with extracorporeal life support were excluded. Results: Both groups had similar distributions of propensity scores. The EVLP group had lower donor pO2s (408.3 +/95.5 mmHg vs 451.3 +/74.3 mmHg, p< 0.0001), a higher proportion of DCD donors (53 [39.8%] vs 7 [5.2%], p< 0.0001), and a higher number of donor smokers (74 [55.6%] vs 59 [44.4%], p= 0.04). Mean EVLP time was 278 +/62.9 min. Kaplan-Meier survival was similar between the two groups (p= 0.30, Fig 1). Freedom from PGD2/3 at 72h was better in the EVLP group (110 [82.7%] vs 91 [68.4%], p= 0.01) with a trend towards lower 30-day mortality (4 [3%] EVLP, 9 [6.8%] non-EVLP, p= 0.17). Median [95%CI] ICU stay (4[3-6]days non-EVLP vs 4[3-4]days EVLP, p= 0.83) and median [95%CI] hospital stay were similar between groups (23[20-27] days non-EVLP vs 21[19-23] days EVLP, p= 0.21). Conclusion: EVLP is a reliable technique for selecting lungs suitable for transplantation. Short and long term outcomes are excellent and comparable or superior to conventionally selected and preserved donor lungs.