title: Functional outcomes and quality of life after normothermic ex vivo lung perfusion lung transplantation.
abstract: BACKGROUND
  Ex vivo lung perfusion (EVLP) is an effective method to assess and improve the function of otherwise unacceptable lungs, alleviating the shortage of donor lungs. The early results with EVLP have been encouraging, but longer-term results, including functional and patient-reported outcomes, are not well characterized.
  
  
  METHODS
  This retrospective single-center study included all lung transplants performed between September 2008 and December 2012. We investigated whether survival or rate of chronic lung allograft dysfunction (CLAD) differed in recipients of EVLP-treated lungs compared with contemporaneous recipients of conventional donor lungs. We also studied functional (highest forced expiratory volume in 1 second predicted, change in 6-minute walk distance, number of acute rejection episodes) and quality of life outcomes.
  
  
  RESULTS
  Of 403 lung transplants that were performed, 63 patients (15.6%) received EVLP-treated allografts. Allograft survival for EVLP and conventional donor lung recipients was 79% vs 85%, 71% vs 73%, and 58% vs 57% at 1, 3, and 5 years after transplant, respectively (log-rank p = not significant). Freedom from CLAD was also similar (log-rank p = 0.53). There were no significant differences in functional outcomes such as highest forced expiratory volume in 1 second predicted (76.5% ± 23.8% vs 75.8% ± 22.8%, p = 0.85), change in 6-minute walk distance (194 ± 108 meters vs 183 ± 126 meters, p = 0.57), or the number of acute rejection episodes (1.5 ± 1.4 vs 1.3 ± 1.3, p = 0.36). The EVLP and conventional donor groups both reported a significantly improved quality of life after transplantation, but there was no intergroup difference.
  
  
  CONCLUSIONS
  EVLP is a safe and effective method of assessing and using high-risk donor lungs before transplantation and leads to acceptable long-term survival, graft function, and improvements of quality of life that are comparable with conventionally selected donor lungs.
authors.affiliation: Toronto Lung Transplant Program, University Health Network, University of Toronto, Ontario, Canada.
authors.forename: Jussi M
authors.initials: JM
authors.lastname: Tikkanen
authors.affiliation: Toronto Lung Transplant Program, University Health Network, University of Toronto, Ontario, Canada.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Cypel
authors.affiliation: Toronto Lung Transplant Program, University Health Network, University of Toronto, Ontario, Canada.
authors.forename: Tiago N
authors.initials: TN
authors.lastname: Machuca
authors.affiliation: Toronto Lung Transplant Program, University Health Network, University of Toronto, Ontario, Canada.
authors.forename: Sassan
authors.initials: S
authors.lastname: Azad
authors.affiliation: Toronto Lung Transplant Program, University Health Network, University of Toronto, Ontario, Canada.
authors.forename: Matthew
authors.initials: M
authors.lastname: Binnie
authors.affiliation: Toronto Lung Transplant Program, University Health Network, University of Toronto, Ontario, Canada.
authors.forename: Chung-Wai
authors.initials: CW
authors.lastname: Chow
authors.affiliation: Toronto Lung Transplant Program, University Health Network, University of Toronto, Ontario, Canada.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Chaparro
authors.affiliation: Toronto Lung Transplant Program, University Health Network, University of Toronto, Ontario, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Hutcheon
authors.affiliation: Toronto Lung Transplant Program, University Health Network, University of Toronto, Ontario, Canada.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Yasufuku
authors.affiliation: Toronto Lung Transplant Program, University Health Network, University of Toronto, Ontario, Canada.
authors.forename: Marc
authors.initials: M
authors.lastname: de Perrot
authors.affiliation: Toronto Lung Transplant Program, University Health Network, University of Toronto, Ontario, Canada.
authors.forename: Andrew F
authors.initials: AF
authors.lastname: Pierre
authors.affiliation: Toronto Lung Transplant Program, University Health Network, University of Toronto, Ontario, Canada.
authors.forename: Thomas K
authors.initials: TK
authors.lastname: Waddell
authors.affiliation: Toronto Lung Transplant Program, University Health Network, University of Toronto, Ontario, Canada.
authors.forename: Shaf
authors.initials: S
authors.lastname: Keshavjee
authors.affiliation: Toronto Lung Transplant Program, University Health Network, University of Toronto, Ontario, Canada. Electronic address: lianne.singer@uhn.ca.
authors.forename: Lianne G
authors.initials: LG
authors.lastname: Singer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D016040:Lung Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010477:Perfusion / Q000379:methods; D011300:Preoperative Care; D011788:Quality of Life; D020127:Recovery of Function; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: chronic lung allograft dysfunction; donor selection; ex vivo lung perfusion; lung function; patient-reported outcomes; transplantation