Longer travel distances and ischemic times with ex vivo lung perfusion in the Composite Allocation Score era: A nationwide analysis.

Abstract

Ex vivo lung perfusion (EVLP) has emerged as a safe and effective method to preserve and assess donor lungs. This study assesses nationwide trends and outcomes of EVLP use after implementation of the Composite Allocation Score (CAS) in 2023. The Organ Procurement and Transplantation Network (OPTN) dataset was used to identify patients who received a lung transplant (LTx) between March 8, 2023, and June 30, 2025. Baseline characteristics, in-hospital outcomes, and 30-, 90- and 180-day graft and patient survival were compared in LTxs performed with and without the use of EVLP. Survival was adjusted for 20 recipient and donor characteristics using a Cox proportional hazards model. EVLP was used in 582 of 6547 (9%) Tx cases by 36 of 70 (51%) LTx centers. EVLP cases had a longer travel distance (P < .001) and longer median ischemic time (P < .001). EVLP was associated with higher rates of postoperative extracorporeal membrane oxygenation (ECMO; P < .001) and ventilatory support at 72 hours (P = .005) and longer median length of hospital stay (P < .001). Unadjusted and adjusted mortality was similar in the EVLP and no-EVLP groups at 30 days (1.62% vs 2.1%; P = .42), 90 days (4.05% vs 4.59%; P = .52), and 180 days (6.93% vs 7.25%; P = .71). Since implementation of the CAS system, EVLP has been associated with longer travel distances and ischemic times. Despite higher rates of post-LTx ECMO and ventilatory support and longer length of stay, LTx using EVLP-preserved donor lungs has comparable graft and patient survival at 30, 90 and 180 days to no-EVLP LTx.