Lung transplantation after ex vivo lung perfusion versus static cold storage: An institutional cost analysis

Abstract

Ex vivo lung perfusion (EVLP) is a novel lung preservation strategy that facilitates the use of marginal allografts; however, it is more expensive than static cold storage (SCS). To understand how preservation method might affect postoperative costs, we compared outcomes and index hospitalization costs among matched EVLP and SCS preserved lung transplant (LTx) recipients at a single, high‐volume institution. A total of 22 EVLP and 66 matched SCS LTx recipients were included; SCS grafts were further stratified as either standard‐criteria (SCD) or extended‐criteria donors (ECD). Median total preservation time was 857, 409, and 438 min for EVLP, SCD, and ECD lungs, respectively (p < .0001). EVLP patients had similar perioperative outcomes and posttransplant survival compared to SCS SCD and ECD recipients. Excluding device‐specific costs, total direct variable costs were similar among EVLP, SCD, and ECD recipients (median $200,404, vs. $154,709 vs. $168,334, p = .11). The median direct contribution margin was positive for EVLP recipients, and similar to that for SCD and ECD graft recipients (all p > .99). These findings demonstrate that the use of EVLP was profitable at an institutional level; however, further investigation is needed to better understand the financial implications of EVLP in facilitating donor pool expansion in an era of broader lung sharing.

Is logistically motivated ex vivo lung perfusion a good idea?

“…The desire for daytime lung transplantation surgery is hampered by the fact that, for many medical centers, it increases costs ( 14 ). However, for our institution, which is a referral cardiothoracic center, prevention of night-time lung transplantation allows us more flexibility when arranging adequate cardiothoracic emergency care.…”

Current status and future potential of ex vivo lung perfusion in clinical lung transplantation

“…These additional costs do not take into account the capital investment required to initiate an EVLP program, train and retain on‐call EVLP staff, and allocate operating room space if EVLP with a non‐portable circuit is being performed. While medial reimbursement for EVLP is highly variable around the country, for high‐volume centers, these costs are offset by the growth in transplant volume that EVLP offers, allowing an EVLP program to be profitable at an institution level 40 . However, for smaller transplant programs where EVLP is used infrequently, the added costs may be difficult to justify.…”

“…While medial reimbursement for EVLP is highly variable around the country, for highvolume centers, these costs are offset by the growth in transplant volume that EVLP offers, allowing an EVLP program to be profitable at an institution level. 40 However, for smaller transplant programs where EVLP is used infrequently, the added costs may be difficult to justify.…”

Machine perfusion organ preservation: Highlights from the American Transplant Congress 2021

“…However, EVLP is costlier than cold storage. Halpern 1 and colleagues from Durham, NC, compared perioperative outcomes and index hospitalization costs from EVLP ( n = 22) and non‐EVLP ( n = 66) lung transplants in a single institution. Excluding device‐specific costs, they observed that direct variable and total index hospitalization costs were higher among EVLP patients.…”