Lung transplantation after ex vivo lung perfusion versus static cold storage: An institutional cost analysis. Issue 2 (2nd September 2021)

• Record Type: Journal Article
• Authors: Halpern, Samantha E.; Kesseli, Samuel J.; Au, Sandra; Krischak, Madison K.; Olaso, Danae G.; Smith, Haley; Tipton, Greg; Jamieson, Ian R.; Barbas, Andrew S.; Haney, John C.; Klapper, Jacob A.; Hartwig, Matthew G.
• Is Part Of: American journal of transplantation. Volume 22:Issue 2(2022)
• Page Start: 552
• Page End: 564
• Publication Date: 2021-09-02
• Subjects: clinical research/practice -- donors and donation: extended criteria -- economics -- health services and outcomes research -- lung transplantation/pulmonology -- organ perfusion and preservation -- patient survival; Transplantation of organs, tissues, etc -- Periodicals; 617.95
• DOI: 10.1111/ajt.16794
• Languages: English
• ISSNs: 1600-6135

Abstract

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. Abstract : Compared to static cold storage, use of ex‐vivo lung perfusion can be profitable at an institutional level and associated with similar post‐transplant outcomes, offering promising new evidence to support ongoing use of this novel, yet expensive technology to expand the donor pool.