Feasibility of Lung Transplantation From Donation After Circulatory Death Donors Following Portable Ex Vivo Lung Perfusion: A Pilot Study J.G.Y. Luc a,b , K. Jackson e , J.G. Weinkauf e , D.H. Freed a,b,c,d , and J. Nagendran a,b,c,d, * a Division of Cardiac Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada; b Mazankowski Alberta Heart Institute, Edmonton, Canada; c Alberta Transplant Institute, Edmonton, Canada; d Canadian National Transplant Research Program, Edmonton, Canada; and e Division of Pulmonary Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada ABSTRACT Background. Donation after circulatory death (DCD) has the potential to significantly alleviate the shortage of transplantable lungs. We report our initial experience with the use of portable ex vivo lung perfusion (EVLP) with the Organ Care System Lung device for evaluation of DCD lungs. Methods. We performed a retrospective review of the DCD lung transplantation (LTx) experience at a single institution through the use of a prospective database. Results. From 2011 to 2015, 208 LTx were performed at the University of Alberta, of which 11 were DCD LTx with 7 (64%) that underwent portable EVLP. DCD lungs preserved with portable EVLP had a significantly shorter cold ischemic time (161 Æ 44 vs 234 Æ 60 minutes, P ¼ .045), lower grade of primary graft dysfunction at 72 hours after LTx (0.4 Æ 0.5 vs 2.1 Æ 0.7, P ¼ .003), similar mechanical ventilation time (55 Æ 44 vs 103 Æ 97 hours, P ¼ .281), and hospital length of stay (29 Æ 11 vs 33 Æ 10 days, P ¼ .610). All patients were alive at 1-year follow-up after LTx with improved functional outcomes and acceptable quality of life compared with before LTx, although there were no intergroup differences. Conclusions. In our pilot cohort, portable EVLP was a feasible modality to increase confidence in the use of DCD lungs with validated objective evidence of lung function during EVLP that translates to acceptable clinical outcomes and quality of life after LTx. Further studies are needed to validate these initial findings in a larger cohort. D ONATION of organs after circulatory death (DCD) has the potential to significantly alleviate the shortage of transplantable lungs and equate to an extra 28% of do- nors [1]. Multiple national and international studies have demonstrated comparable survival of DCD lung recipients compared with donation after brain death (DBD) lung recipients [2e6]. Despite this, an analysis of the Scientific Registry of Transplant Recipients from 2006 to 2014 for lung transplantation reports that of 7690 DCD and 58,283 DBD donor lungs, only 162 DCD lungs were used (2.1% of those donated), compared with 12,495 DBD lungs (21.4%) [7]. Non-portable normothermic ex vivo lung perfusion (EVLP) has been used as a technique to prevent lung injury compared with extended cold static preservation [8], assess and recon- dition suboptimal donor lungs, including DCD lungs, with successful clinical lung transplantation (LTx) [9,10]. The Organ Care System (OCS Lung) (Transmedics) is the only portable device for EVLP that is designed to minimize This work was supported by the Alberta Transplant Institute, the University Hospital Foundation (UHF), and the Canadian In- stitutes of Health ResearcheCanadian National Transplant Research Program (CIHR-CNTRP). J.G.Y. Luc was funded by the American Association for Thoracic Surgery (AATS) Summer Intern Scholarship and the Alberta InnovateseHealth Solutions (AIHS) Summer Studentship. *Address correspondence to Jayan Nagendran, Division of Cardiac Surgery, Department of Surgery, University of Alberta and Mazankowski Alberta Heart Institute, 4-108A Li Ka Shing Health Research Centre, Edmonton, Alberta, Canada T6G-2E1. E-mail: jayan@ualberta.ca ª 2017 Elsevier Inc. All rights reserved. 230 Park Avenue, New York, NY 10169 0041-1345/17 http://dx.doi.org/10.1016/j.transproceed.2017.04.010 Transplantation Proceedings, 49, 1885e1892 (2017) 1885