Donor Characteristics of Lungs Assessed Using Remote Ex Vivo Lung Perfusion at a Centralized Evaluation Facility
Mayo Clinic Florida
Jacksonville, FL
United States - Contact Me
Jorge M Mallea, M.D. is a consultant in the Department of Critical Care Medicine, he holds a Joint appointment in the Department of Trnaplanstantion and the Center for Regenerative Biotherapeutics (CRB) at Mayo Clinic Florda. He serves as the medical director for Lung Bioengineering Jacksonville (LB-JAX) a joint project between Mayo Clinic and Lung Biothechnology (a subsidiary of United Therapeutics). He is the chair for CRB’s equity, inclusion and diversity committee.
Dr. Mallea received his M.D. degree at the Universidad Nacional de San Agustin. He completed a residency in Internal Medicine at New York Medial College in New York. He received further fellowship training in Pulmonary, Critical Care and Sleep Medicine at Saint Louis University, Missouri. He joined the lung transplant team at Mayo Clinic Florida in 2011.
Dr. Mallea’s research interests include lung repair and regeneration, and organ preservation. He is conducting a FDA-approved clinical trial to evaluate the safety of mesenchymal stem cells in patients with advanced Chronic Obstructive Pulmonary Disease. He has served as principal investigator in industry sponsored clinical trials involving endobronchial valves to treat emphysema and centralized ex vivo lung perfusion facilities.
Dr. Mallea is the upcoming chair for the American Society of Transplant Recovery and Preservation Community of Practice. He is a fellow of the American College of Chest Physicians and the American Academy of Sleep Medicine. He holds membership in other national and international professional societies.
Description
Remote ex vivo lung perfusion (EVLP) allows for evaluation of donor lungs that otherwise would have been discarded. After a clinical trial demonstrated the feasibility of remote EVLP, centralized evaluation facilities became operational. Real-world outcomes reports showed similar outcomes to the clinical trial for remote EVLP. The characteristics of the donor lungs referred to these facilities is not well known. We report the characteristics of lung grafts referred for evaluation to a centralized EVLP facility located in Jacksonville, FL. from December 2, 2020, to May 30, 2024.
Methods:
We performed a retrospective analysis of donor lungs referred to a centralized lung evaluation facility for remote EVLP between 12/2020 -05/2024. We report the donor characteristics of lungs accepted and rejected for transplantation. Chi-square test was used to compare categorical variables, continuous variables were compared using Mann-Whitney U test.
Results:
Two-hundred-seventy-two lungs were referred for remote EVLP. Thirteen lungs (6 DBDs, 7 DCDs) were not perfused due to poor graft quality and were excluded from the analysis. One-hundred-forty-three cases were referred by 12 transplant centers while the rest were referred by 31 distinct OPOs. Most lung grafts came from DBD donors (71% or 183 of 259). Overall, 144 of 259 perfused lungs were transplanted (utilization=55.6%). The utilization was 60% (109 out of 183) and 46% (35 out of 76) for DBD and DCD lungs, respectively. The utilization was 54% (75/139) for lungs referred by transplant centers and 57% (69/120) for lungs referred by OPOs (p=0.046). Lungs from female donors were accepted at a higher percentage than donors from male donors (p=0.03). Lungs from non-smokers were accepted at a higher percentage than smokers of 10 pack-years or more (p=0.040). Donor's age, chest x-ray (normal/abnormal), sputum culture results (positive/negative), bronchoscopy findings (normal /abnormal) and PaO2/FiO2 were similar between the lungs accepted for transplant and the lungs rejected for transplant after EVLP. The cold ischemia time between cross-clamp and initiation of EVLP was similar for both groups (Table 1).
Conclusions:
In the United States transplant centers and OPO's referred lung grafts for remote EVLP at a centralized facility. The utilization rate of lungs referred to a centralized EVLP facility located in Jacksonville Florida is similar to previous reports (56%). DBD lungs have a higher utilization rate than DCD lungs. Most donor characteristics and CIT-1 were similar between the lungs accepted for transplantation and the lungs that were not accepted for transplantation.
Authors
Jorge Mallea (1), Amaya Moats (1), Sebastian Vega-Rivera (1), Daphne Gomez Escudero (2)
Institutions
(1) Mayo Clinic Florida, Jacksonville, FL, (2) Lung Bioengineering, Jacksonville, FL