Impact of ex vivo lung perfusion evaluation on donation after circulatory death in lung transplantation.

Authors

Mariana Gil-Barturen, Laura Donahoe, Marc de Perrot, Kazuhiro Yasufuku, Andrew Pierre, Elliot Wakeam, Thomas K Waddell, Shaf Keshavjee, Marcelo Cypel, Jonathan C Yeung

Published in

JTCVS techniques. Volume 38. Pages 102416. Epub May 15, 2026.

Abstract

As the result of increased warm ischemia time and limited intraoperative evaluation, donation after circulatory death (DCD) donors might be considered greater risk, and use lags behind donation after brain death (DBD). Ex vivo lung perfusion (EVLP) provides an opportunity to better evaluate DCD lungs, and we sought to examine our outcomes.
A single-center retrospective review of a prospectively collected database was performed for DCD donor lung transplants (LTx) from January 1, 2007, to August 8, 2024. DCD donors were stratified into EVLP (EVLP-DCD) and non-EVLP (non-EVLP-DCD) groups. Donor and recipient demographics, donor quality metrics, post-LTx outcomes, and overall survival were collected.
In total, 2282 LTx were performed from 2007 to 2024, and 467 (20.5%) were from DCD. EVLP was used in 257 (55%) of DCD. Between EVLP-DCD and non-EVLP-DCD, there was similar primary graft dysfunction grade 3 at 72 hours (14.0% vs 13.3%, P = .735) and no survival difference (P = .28). EVLP-DCD cases had shorter stay in the intensive care unit (median 4 vs 6 days; P < .001) but similar hospital stay (median 22 vs 24 days; P = .162). EVLP-DCD donors had longer time from withdrawal to flush (59 vs 43 minutes; P < .001) and a significantly greater rate of Gram stain-positive cultures (62.6% vs 41.9%; P < .001). The proportion of DCD transplants increased from 6.2% in 2008 to 54.9% in 2025.
Transplantation of DCD lungs evaluated by EVLP had comparable outcomes compared with non-EVLP-evaluated DCD lungs and DBD lungs. Liberal use of EVLP evaluation has led to safe and increased use of DCD lungs despite their unpredictably greater risk.

PMID:
42577007
Bibliographic data and abstract were imported from PubMed on 11 Aug 2026.

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