Retrospective Study
Copyright ©The Author(s) 2025.
World J Transplant. Sep 18, 2025; 15(3): 102150
Published online Sep 18, 2025. doi: 10.5500/wjt.v15.i3.102150
Table 1 Recipient characteristics, n (%)
Variable
Overall (n = 897)
Cold static storage (n = 792)
Ex vivo lung perfusion (n = 105)
P value
Age64 (57, 68)64 (57, 68)63 (56, 68)0.365
Male sex551 (61.4)490 (61.9)61 (58.1)0.522
Race0.816
White659 (73.5)582 (73.5)77 (73.3)
Black89 (9.9)77 (9.7)12 (11.4)
Other149 (16.6)133 (16.8)16 (15.2)
Body mass index (kg/m2)26.6 (23.3, 29.4)26.7 (23.3, 29.4)26.4 (23.7, 29.3)0.67
Diabetes150 (16.8)128 (16.3)22 (21)0.286
Former smoker509 (56.7)444 (56.1)65 (61.9)0.404
Glomerular filtration rate (mL/minute/1.73 m2)91 (74.6, 119.3)90.3 (74.4, 117.8)97.2 (76.7, 125.3)0.286
Mean pulmonary artery pressure (mm Hg)25 (20, 30.5)25 (20, 30)24 (21, 32)0.477
Diagnosis0.755
Cystic fibrosis/immunodeficiency24 (2.7)21 (2.7)3 (2.9)
Obstructive lung disease207 (23.1)179 (22.6)28 (26.7)
Pulmonary vascular disease36 (4)31 (3.9)5 (4.8)
Restrictive lung disease630 (70.2)561 (70.8)69 (65.7)
Lung allocation score41.2 (35.7, 55.2)41.3 (35.8, 55.9)40.5 (35.5, 53.7)0.434
Hospitalized prior to transplant0.8
Not hospitalized643 (75.5)561 (75.1)82 (78.1)
Hospitalized82 (9.6)73 (9.8)9 (8.6)
In intensive care unit127 (14.9)113 (15.1)14 (13.3)
Pre-operative ventilator47 (5.2)44 (5.6)3 (2.9)0.351
Pre-operative extracorporeal membrane oxygenation58 (6.5)54 (6.8)4 (3.8)0.334
Days on wait list34 (12, 117)33 (12, 116)42 (14, 122)0.482
Table 2 Donor characteristics, n (%)
Variable
Overall (n = 897)
Cold static storage (n = 792)
Ex vivo lung perfusion (n = 105)
P value
Age35 (25, 48)35 (24, 47)38 (25, 51)0.082
Male sex562 (62.7)497 (62.8)65 (61.9)0.951
Coronary artery disease57 (6.5)52 (6.8)5 (4.8)0.585
Smoking history86 (9.8)74 (9.6)12 (11.5)0.648
Recent cocaine use195 (22.1)172 (22.1)23 (22.1)0.5
Diabetes95 (10.7)84 (10.7)11 (10.6)0.999
Hypertension240 (26.9)211 (26.8)29 (27.6)0.954
Alcohol abuse180 (20.7)162 (21.2)18 (17.3)0.429
Body mass index (kg/m2)26 (23, 30)25.9 (23, 29.9)27.1 (23, 32.7)0.15
PaO2/FiO2 ratio449 (396.9, 506)454 (400, 507.4)408.5 (361, 487.1)< 0.001
Donor cause of death0.568
Neuro (seizure/cerebral vascular accident)259 (28.9)231 (29.2)28 (26.9)
Drug overdose136 (15.2)126 (15.9)10 (9.6)
Asphyxiation56 (6.2)48 (6.1)8 (7.7)
Cardiovascular71 (7.9)61 (7.7)10 (9.6)
Trauma (gun shot wound/stab/blunt)331 (36.9)290 (36.6)41 (39.4)
Drowning4 (0.4)3 (0.4)1 (1)
Other39 (4.4)33 (4.2)6 (5.8)
Donation after circulatory death94 (10.5)62 (7.8)32 (30.5)< 0.001
Table 3 Transplant outcomes, n (%)
Variable
Overall (n = 897)
Cold static storage (n = 792)
Ex vivo lung perfusion (n = 105)
P value
Center volume30 (12, 56)30 (12, 56)32 (14, 56)0.526
Center volume yearly2 (0.8, 3.7)2 (0.8, 3.7)2.1 (0.9, 3.7)0.526
Perfused by
Organ perfusion organization2 (1.9)
Transplant program61 (58.7)
External perfusion center41 (39.4)
Perfusion time296 (218, 496)
Warm ischemic time24 (19.3, 28)24 (19, 26.8)25.5 (20, 30.3)0.113
Type of lung transplant0.001
Bilateral653 (72.8)561 (70.8)92 (87.6)
Right single100 (11.1)96 (12.1)4 (3.8)
Left single144 (16.1)135 (17)9 (8.6)
Distance traveled (nautical miles)898 (824, 1006)900 (824, 1006)892 (826, 1058)0.96
Ischemic time (hours)7.3 (6.2, 8.8)7.1 (6.1, 8.2)13.5 (10.8, 16.2)< 0.001
Length of stay (days)20 (13, 38)20 (13, 37)22 (14, 48.5)0.553
In-hospital mortality59 (7.2)50 (7)9 (8.7)0.668
Postop dialysis81 (9.6)65 (8.8)16 (15.4)0.049
Postop stroke34 (4)30 (4)4 (3.8)0.999
Airway dehiscence16 (1.9)16 (2.2)0 (0)0.254
Post-operative extracorporeal membrane oxygenation97 (11.5)79 (10.7)18 (17.3)0.068
Post-operative ventilator0.011
None7 (0.8)5 (0.7)2 (1.9)
< 2 days445 (53.1)405 (55.1)40 (38.8)
2-5 days167 (19.9)143 (19.5)24 (23.3)
5+ days219 (26.1)182 (24.8)37 (35.9)
Primary graft dysfunction grade 3123 (13.7)108 (13.6)15 (14.3)0.975
Acute rejection (hospitalization)0.014
Yes and treated with immunosuppressant49 (5.8)38 (5.1)11 (10.5)
Yes and not treated with Immunosuppressant5 (0.6)3 (0.4)2 (1.9)
No792 (93.6)700 (94.5)92 (87.6)
Treated rejection (1st year)84 (16.2)63 (13.9)21 (30.9)0.001
Cause of death0.827
Graft failure35 (17.9)32 (18.3)3 (15)
Malignancy4 (2.1)4 (2.3)0 (0)
Cardio/cerebrovascular29 (14.9)25 (14.3)4 (20)
Pulmonary33 (16.9)29 (16.6)4 (20)
Infection58 (29.7)51 (29.1)7 (35)
Other36 (18.5)34 (19.4)2 (10)
Year of transplant
201896 (10.7)83 (10.5)13 (12.4)
2019142 (15.8)122 (15.4)20 (19)
2020170 (19)153 (19.3)17 (16.2)
2021209 (23.3)180 (22.7)29 (27.6)
2022220 (24.5)197 (24.9)23 (21.9)
202360 (6.7)57 (7.2)3 (2.9)
Table 4 Matched recipient characteristics, n (%)
Variable
Overall (n = 416)
Cold static storage (n = 312)
Ex vivo lung perfusion (n = 104)
P value
Age62 (55.8, 67)62 (55.8, 67)63 (55.5, 68)0.621
Male sex244 (58.7)183 (58.7)61 (58.7)0.999
Race0.92
White305 (73.3)229 (73.4)76 (73.1)
Black44 (10.6)32 (10.3)12 (11.5)
Other67 (16.1)51 (16.3)16 (15.4)
Body mass index (kg/m2)26.4 (23, 29.2)26.4 (23, 29.2)26.4 (23.6, 29.3)0.75
Diabetes95 (22.8)73 (23.4)22 (21.2)0.736
Former smoker236 (56.7)171 (54.8)65 (62.5)0.209
Glomerular filtration rate (mL/minute/1.73 m2)93.8 (76, 121.1)93.2 (76, 118)97.6 (76.5, 125.5)0.54
Mean pulmonary artery pressure (mm Hg)24 (20, 31)24 (19, 31)24 (21, 31.5)0.457
Diagnosis0.999
Cystic fibrosis/immunodeficiency12 (2.9)9 (2.9)3 (2.9)
Obstructive lung disease114 (27.4)86 (27.6)28 (26.9)
Pulmonary vascular disease20 (4.8)15 (4.8)5 (4.8)
Restrictive lung disease270 (64.9)202 (64.7)68 (65.4)
Lung allocation score40.5 (34.9, 52.7)40.4 (34.6, 52.8)40.5 (35.4, 52.2)0.987
Hospitalized prior to transplant0.992
Not hospitalized324 (77.9)243 (77.9)81 (77.9)
Hospitalized35 (8.4)26 (8.3)9 (8.7)
In intensive care unit57 (13.7)43 (13.8)14 (13.5)
Pre-operative ventilator18 (4.3)15 (4.8)3 (2.9)0.578
Pre-operative extracorporeal membrane oxygenation24 (5.8)20 (6.4)4 (3.8)0.466
Days on wait list38 (12, 123)34.5 (12, 121.8)41.5 (13.8, 123)0.765
Table 5 Matched donor characteristics, n (%)
Variable
Overall (n = 416)
Cold static storage (n = 312)
Ex vivo lung perfusion (n = 104)
P value
Age38 (27, 51)38.5 (28, 51)38 (25, 51.2)0.708
Male sex250 (60.1)186 (59.6)64 (61.5)0.817
Coronary artery disease27 (6.5)22 (7.1)5 (4.9)0.58
Smoking history41 (10)29 (9.5)12 (11.5)0.677
Recent cocaine use98 (23.6)75 (24.1)23 (22.1)0.209
Diabetes41 (9.9)30 (9.6)11 (10.6)0.924
Hypertension116 (27.9)88 (28.2)28 (26.9)0.9
Alcohol abuse95 (23.1)77 (25.1)18 (17.3)0.136
Body mass index (kg/m2)27.2 (23.7, 30.8)27.3 (24.1, 30.7)27 (22.9, 32.1)0.544
PaO2/FiO2 ratio446 (394, 503.1)453.5 (400, 504.2)409 (360, 488.2)0.001
Donor cause of death0.252
Neuro (seizure/cerebral vascular accident)118 (28.4)91 (29.2)27 (26.2)
Drug overdose58 (14)48 (15.4)10 (9.7)
Asphyxiation20 (4.8)12 (3.8)8 (7.8)
Cardiovascular41 (9.9)31 (9.9)10 (9.7)
Trauma (gun shot wound/stab/blunt)154 (37.1)113 (36.2)41 (39.8)
Drowning1 (0.2)0 (0)1 (1)
Other23 (5.5)17 (5.4)6 (5.8)
Donation after circulatory death56 (13.5)25 (8)31 (29.8)< 0.001
Table 6 Matched transplant outcomes, n (%)
Variable
Overall (n = 416)
Cold static storage (n = 312)
Ex vivo lung perfusion (n = 104)
P value
Center volume32 (14, 56)32 (14, 56)32 (14, 56)0.761
Center volume yearly2.1 (0.9, 3.7)2.1 (0.9, 3.7)2.1 (0.9, 3.7)0.761
Perfused by
Organ perfusion organization0 (N/A)2 (1.9)
Transplant program0 (N/A)61 (59.2)
External perfusion center0 (N/A)40 (38.8)
Perfusion time294.5 (217, 507)
Warm ischemic time24 (19.7, 28.5)23 (18, 26)25 (20, 30)0.129
Type of lung transplant0.009
Bilateral319 (76.7)228 (73.1)91 (87.5)
Right single40 (9.6)36 (11.5)4 (3.8)
Left single57 (13.7)48 (15.4)9 (8.7)
Distance traveled (nautical miles)894 (826, 1006.2)900 (825.5, 1000.8)892 (826.8, 1062.8)0.862
Ischemic time (hours)7.7 (6.4, 10.3)7.1 (6.1, 8.2)13.6 (10.8, 16.2)< 0.001
Length of stay (days)19 (13, 37)19 (13, 35.8)22 (14, 48.5)0.278
In-hospital mortality31 (7.7)22 (7.3)9 (8.7)0.798
Postop dialysis38 (9.2)23 (7.4)15 (14.6)0.046
Postop stroke18 (4.3)14 (4.5)4 (3.8)0.99
Airway dehiscence10 (2.4)10 (3.2)0 (0)0.139
Post-operative extracorporeal membrane oxygenation43 (10.4)26 (8.3)17 (16.5)0.03
Post-operative ventilator0.02
None6 (1.5)4 (1.3)2 (2)
< 2 days213 (51.8)173 (56)40 (39.2)
2-5 days87 (21.2)63 (20.4)24 (23.5)
5+ days105 (25.5)69 (22.3)36 (35.3)
Primary graft dysfunction grade 359 (14.2)45 (14.4)14 (13.5)0.935
Acute rejection (hospitalization)0.052
Yes and treated with immunosuppressant26 (6.2)15 (4.8)11 (10.6)
Yes and not treated with Immunosuppressant4 (1)2 (0.6)2 (1.9)
No386 (92.8)295 (94.6)91 (87.5)
Treated rejection (1st year)44 (17.7)23 (12.7)21 (30.9)0.002
Cause of death0.625
Graft failure17 (18.1)14 (18.7)3 (15.8)
Malignancy1 (1.1)1 (1.3)0 (0)
Cardio/cerebrovascular13 (13.8)9 (12)4 (21.1)
Pulmonary16 (17)12 (16)4 (21.1)
Infection31 (33)24 (32)7 (36.8)
Other16 (17)15 (20)1 (5.3)
Year of transplant
201844 (10.6)31 (9.9)13 (12.5)
201969 (16.6)49 (15.7)20 (19.2)
202088 (21.2)71 (22.8)17 (16.3)
202199 (23.8)70 (22.4)29 (27.9)
2022109 (26.2)87 (27.9)22 (21.2)
20237 (1.7)4 (1.3)3 (2.9)