Ex Vivo Lung Evaluation of Single Donor Lungs when the Contralateral Lung is Rejected Increases Safe Use

Objective: The decision to perform a single-lung transplant (SLT) when the contra-lateral donor lung is rejected is a challenging scenario. The introduction of ex vivo lung perfusion (EVLP) has improved donor lung assessment, and we hypothesize that it has improved SLT outcomes in this setting.Methods: A retrospective single-center review of all SLTs performed between 2000 and 2017 was performed in which the years 2000 to 2008 were considered the "pre-EVLP era" and 2009 to 2017 the "EVLP era." Recipients of SLT lungs when the contra-lateral lung was declined were classified into 3 groups: (1) Pre-EVLP era, (2a) EVLP era but EVLP not used, and (2b) EVLP era and EVLP used. The outcomes of interest were survival, time-to-extubation, and intensive care unit and hospital stay.Results: Among 1692 transplants between 2000 and 2017, 244 (14%) were SLT. SLT rate was similar between eras (pre-EVLP 16% vs EVLP 15%), but more SLTs were performed where the contralateral lung was declined in the EVLP era (pre-EVLP 32% vs EVLP 45%, P 1/4 .04). Lungs evaluated on EVLP had lower procure-ment partial pressure of oxygen and were more often from donation after cardiac death donors. Recipients were generally also sicker, with a greater proportion of rapidly deteriorating recipients. Despite this, outcomes were similar between eras with a trend towards lower 30-day mortality in the EVLP era.Conclusions: The availability of EVLP allowed for better evaluation of marginal sin-gle lungs when the contralateral was declined. This has led to increased use rates with preserved outcomes despite use of more extended criteria organs. (J Thorac Cardiovasc Surg 2023;165:526-31)