Ex Vivo Lung Perfusion in Donation After Cardiac and Brain Death Donation

BACKGROUND Allografts from donation after circulatory death (DCD) or brain death donors may be evaluated by ex vivo lung perfusion (EVLP) to assess quality for transplantation. We sought to determine the association of donor type with transplantation outcomes at a national level. METHODS The United Network for Organ Sharing database was queried for lung transplant re- cipients, who were stratified into DCD EVLP, brain death EVLP, standard DCD, and standard brain death, followed by an unadjusted analysis. A 1:1 propensity score match based on donor and recipient characteristics was used to compare DCD vs DCD EVLP, brain death vs brain death EVLP, and brain death vs DCD EVLP. The cohorts were assessed with comparative statistics. Finally, static EVLP and portable EVLP were compared to determine independent association with increased death. RESULTS The unadjusted DCD EVLP group had significantly higher incidence of postoperative morbidity and death. The 3-year survival was significantly lower in the DCD EVLP group, 65.3% (P = .026). After matching, the EVLP groups had significantly higher morbidity and in-hospital death (DCD EVLP vs brain death), but midterm survival was no longer significantly different. However, the DCD EVLP group had about '6% lower survival than the DCD group (P = .05) and about '7% lower survival than the brain death group (P = .12). Within the EVLP groups, static EVLP and portable EVLP were not independently associated with increased death. CONCLUSIONS Expansion of DCD EVLP allografts increases organ access, although providers should be aware of potential increases in complications and death compared with DCD alone. (Ann Thorac Surg 2025;119:651-60) (c) 2025 Published by Elsevier Inc. on behalf of The Society of Thoracic Surgeons