External Perfusion Centers Can Bridge the Gap of Experience During Ex Vivo Lung Perfusion: A United Network for Organ Sharing Database Study

Previously, limited cumulative experience has been linked to poor transplantation outcomes following ex vivo lung perfusion (EVLP). We sought to determine if EVLP performed at external perfusion centers (EPC) could mitigate this effect. Recipients from the United Network for Organ Sharing Database were stratified into: high-volume transplant program (HV-TP), low-volume transplant program (LV-TP), and EPC, based on who performed EVLP. Comparative statistics and Kaplan-Meier survival analysis were used, with a multivariable Cox regression model identifying independent mortality risk factors. A subgroup analysis compared LV transplant centers using EPCs (LV-EPC) against HV-TP recipients. The LV-TP group had a significantly higher incidence of postoperative ECMO use (20.8%, p = 0.009) and primary graft dysfunction grade 3 (PGD3) (30.1%, p = 0.011). However, survival did not significantly differ between groups, and LV-TP was not independently associated with increased mortality. Subgroup analysis showed that the LV-EPC had significantly shorter hospital stay when compared with HV-TP (20.5 vs. 24 days, p = 0.01) and equivocal rates of PGD3 (p = 0.204), with no survival or independent mortality difference on multivariable analysis. External perfusion centers can mitigate postoperative complications associated with LV transplant centers. For centers with limited EVLP experience, EPCs offer a viable alternative pathway to expand the donor pool.