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27 December 2019 : Review article  

The Conversional Efficacy of Ex Vivo Lung Perfusion and Clinical Outcomes in Patients Undergoing Transplantation of Donor Lungs by Ex Vivo Lung Perfusion: A Meta-Analysis

Qiuping Luo1ACE, Linhai Zhu2ACE*, Yiqing Wang2BD, Luming Wang2BF, Wang Lv2BG, Jian Hu2AG

DOI: 10.12659/AOT.919242

Ann Transplant 2019; 24:647-660

Abstract

Background: Ex vivo lung perfusion (EVLP) is a relatively new technique that can be used to assess and repair the donor lungs, increasing the utilization of high-risk lungs. However, its effect on outcomes of lung transplantation patients is uncertainty. This meta-analysis is conducted to assess the impact of EVLP on donor lungs and outcomes of recipients compared with the standard lung transplantation. Material/Methods: We systematically searched for studies comparatively analyzing the efficacy of EVLP and standard cold storage in lung transplantation. The hazard ratio (HR), relative risk (RR), and weighted mean difference (WMD) were used as the effect size (ES) to evaluate the survival outcomes, categorical variables, and continuous variables respectively. Results: A total of 20 published articles (including 2574 donors and 2567 recipients) were eligible. The chest x-ray manifestations and PaO₂/FiO₂ 100% were more deficient in the EVLP group than the standard group. EVLP improved the function of high-risk donor lungs with the conversion rate ranging from 34% to 100%. The EVLP group had a lower incidence of primary graft dysfunction 3, but longer intensive care unit stay. Other clinical outcomes between the 2 groups were similar. Conclusions: The pooled results indicated that EVLP could be used to assess and improve high-risk donor lungs and had non-inferior postoperative outcomes compared with the standard cold storage. EVLP not only increased the utilization of marginal donors, but also could extend preservation time and reduce the total ischemia time of donors.

Keywords: Donor Selection, Lung Transplantation, Perfusion, Extracorporeal Circulation, In Vitro Techniques, Lung, Organ Preservation, Tissue and Organ Procurement

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Annals of Transplantation eISSN: 2329-0358
Annals of Transplantation eISSN: 2329-0358