Determining the impact of ex-vivo lung perfusion on hospital costs for lung transplantation: A retrospective cohort study

Peel, John K.; Keshavjee, Shaf; Naimark, David; Liu, Mingyao; Sorbo, Lorenzo Del; Cypel, Marcelo; Barrett, Kali; Pullenayegum, Eleanor; Sander, Beate

doi:10.1016/j.healun.2022.10.016

Cited by 13 publications

(16 citation statements)

References 39 publications

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“…In addition, the multifactorial etiology of pretransplant deaths may contribute an explanation: restrictive and pulmonary vascular diseases were associated with higher likelihood of waitlist mortality and lower likelihood of receiving an organ. We previously reported a considerably higher incidence of restrictive disease in the modern era: increased enrollment of these higher risk patients reflects a shift in practice that offsets any expected improvement caused by increased organ availability 15 . Our observation that the likelihood of PGD3 was not affected by EVLP era may be additionally explained by this phenomenon.…”

Section: Discussionmentioning

confidence: 59%

“…We grouped patients according to EVLP availability into 3, a priori defined eras based on referral date (patients) or retrieval date (organs) relative to when EVLP was introduced into practice: pre-EVLP (January 2005–August 2008); early EVLP (August 2008–December 2012); and modern (January 2013–December 2019) 15 . To minimize misclassification risk, outcomes in the pre-EVLP era were censored at January 1, 2013, and posttransplant observations were limited to 2500 days.…”

Section: Methodsmentioning

confidence: 99%

“…UHN introduced clinical funding for EVLP in 2013. The 2008–2013 was expected to reflect the consequences of EVLP’s implementation instead of the technology’s intended use: a priori planned exclusion of the early EVLP era was an attempt to minimize unmeasured confounding related to technology implementation 15 …”

Section: Methodsmentioning

confidence: 99%

“…The decision to fund EVLP and integrate it into transplant programs must be supported by evidence that considers the resource allocation implications of the technology. Our group previously evaluated the costs associated with EVLP, but the resource allocation and clinical implications remained unclear 15 . Thus, we sought to determine whether EVLP had a meaningful impact on organ transplantation rates.…”

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confidence: 99%

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Evaluating the Impact of Ex-Vivo Lung Perfusion on Organ Transplantation

et al. 2023

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Background: Ex vivo lung perfusion (EVLP) sustains and allows advanced assessment of potentially useable donor lungs before transplantation, potentially relieving resource constraints. Objective: We sought to characterize the effect of EVLP on organ utilization and patient outcomes. Methods: We performed a retrospective, before-after cohort study using linked institutional data sources of adults wait-listed for lung transplant and donor organs transplanted in Ontario, Canada between 2005 and 2019. We regressed the annual number of transplants against year, EVLP use, and organ characteristics. Time-to-transplant, waitlist mortality, primary graft dysfunction, tracheostomy insertion, in-hospital mortality, and chronic lung allograft dysfunction were evaluated using propensity score-weighted regression. Results: EVLP availability (P=0.01 for interaction) and EVLP use (P<0.001 for interaction) were both associated with steeper increases in transplantation than expected by historical trends. EVLP was associated with more donation after circulatory death and extended-criteria donors transplanted, while the numbers of standard-criteria donors remained relatively stable. Significantly faster time-to-transplant was observed after EVLP was available (hazard ratio=1.64 [1.41–1.92]; P<0.001). Fewer patients died on the waitlist after EVLP was available, but no difference in the hazard of waitlist mortality was observed (HR=1.19 [0.81–1.74]; P=0.176). We observed no difference in the likelihood of chronic lung allograft dysfunction before versus after EVLP was available. Conclusions: We observed a significant increase in organ transplantation since EVLP was introduced into practice, predominantly from increased acceptance of donation after circulatory death and extended-criteria lungs. Our findings suggest that EVLP-associated increases in organ availability meaningfully alleviated some barriers to transplant.

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Section: Discussionmentioning

confidence: 59%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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confidence: 99%

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Evaluating the Impact of Ex-Vivo Lung Perfusion on Organ Transplantation

et al. 2023

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“…Another study reports a staggering cost of around $80,000 USD per use, not including the cost of at least five staff members required to work with the device (68). These numbers are similar in magnitude to estimated costs per transplant utilizing EVLP, which suggest that the net cost (including disposable supplies) would be in the neighborhood of $20,000-60,000 USD (76). While there exists very little study on the cost-effectiveness of ESHP, studies of EVLP have deemed the method cost effective at the institutional level, facilitating faster progression to transplantation without a significant increase in cost (76,77).…”

Section: The Cost Effectiveness Of Nmp and The Impact Of Machine Perf...mentioning

confidence: 89%

Thoracic organ machine perfusion: A review of concepts with a focus on reconditioning therapies

Wagner

Hatami²,

Freed³

2023

Front. Transplant.

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Thoracic organ transplantation, including lung, heart, and heart-lung transplants are highly regarded as gold standard treatments for patients suffering from heart failure or chronic end stage lung conditions. The relatively high prevalence of conditions necessitating thoracic organ transplants combined with the lack of available organs has resulted in many either dying or becoming too ill to receive a transplant while on the waiting list. There is a dire need to increase both the number of organs available and the utilization of such organs. Improved preservation techniques beyond static storage have shown great potential to lengthen the current period of viability of thoracic organs while outside the body, promising better utilization rates, increased donation distance, and improved matching of donors to recipients. Ex-situ organ perfusion (ESOP) can also make some novel therapeutic strategies viable, and the combination of the ESOP platform with such reconditioning therapies endeavors to better improve functional preservation of organs in addition to making more organs viable for transplantation. Given the abundance of clinical and pre-clinical studies surrounding reconditioning of thoracic organs in combination with ESOP, we summarize in this review important concepts and research regarding thoracic organ machine perfusion in combination with reconditioning therapies.

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The Next Frontier in Lung Transplantation: Protecting the Endothelium and Repairing Organs for Transplant Utilizing MG53

Gouchoe,

Whitson,

Zhu

2023

Clinical and Translational Dis

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Lung transplantation is plagued by limited access to suitable donor organs. While organs traditionally come from brain dead donors (BDD), these organs from a standard donor do not currently meet the demand of those on the wait list. 1 In recent years, extended criteria donors (ECD) (i.e., donors that were traditionally thought to be of poorer quality) have been utilized with increasing rates and success. 2 However, limitations still exist on the immediate function and long-term implications of their use. 3 ECD, due to their baseline quality, often suffer a disproportionate amount of warm ischemia during the agonal phase of the organ recovery process. Upon their implantation, the reperfusion injury afflicting these allografts triggers a litany of harmful processes (necroptosis, pyroptosis, etc.) that are the cause of immediate poor allograft function and possibly lead to long-term consequences. This process is known as ischemia reperfusion injury (IRI), and all transplanted organs suffer a degree of this injury. At the cellular level, IRI leads to degradation of the pulmonary vascular endothelium, which allows for an influx of immune cells into the alveoli leading to further damage and pulmonary edema. 4 Clinically, the consequence of this inflammatory cascade results in primary graft dysfunction (PGD) within the first 72 h post-transplant, which has deleterious consequences in the immediate post-operative period 5,6 and can lead to long term rejection. [5][6][7] PGD, like any form of acute lung injury (ALI) directly results in endothelial alteration. 8 At the site of gas exchange, the alveolo-endothelial membrane consists of a thin layer of pulmonary vascular endothelial cells and alveolar epithelial cells with their basement membranes fused together. 9 In addition to facilitating the exchange of oxygen, small amounts of fluid also cross this barrier, which is subsequently drained by lymphatics. 10 Upon damage of the pulmonary endothelium (i.e. by IRI), the basement membrane is exposed thus initiating a phenotypic shift from an anti-thrombotic/anti-inflammatory state to a dysfunctional disposition resulting in un-inhibited inflam-This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

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Determining the impact of ex-vivo lung perfusion on hospital costs for lung transplantation: A retrospective cohort study

Cited by 13 publications

References 39 publications

Evaluating the Impact of Ex-Vivo Lung Perfusion on Organ Transplantation

Evaluating the Impact of Ex-Vivo Lung Perfusion on Organ Transplantation

Thoracic organ machine perfusion: A review of concepts with a focus on reconditioning therapies

The Next Frontier in Lung Transplantation: Protecting the Endothelium and Repairing Organs for Transplant Utilizing MG53

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