Limited donor lung availability and prolonged wait times remain substantial barriers to lung transplant. According to the Scientific Registry of Transplant Recipients, 11% of patients were removed from the wait-list in 2017 because of death or clinical deterioration and 40% of patients waited longer than 1 year before transplant.¹ Ex vivo lung perfusion (EVLP) provides the opportunity to expand the donor pool, but despite encouraging early posttransplant outcomes,^2,3 the long-term effect of EVLP remains unclear. In this issue of JAMA Surgery, Divithotawela et al⁴ present 10-year outcomes of the Toronto Lung Transplant Group’s experience with normothermic EVLP for lungs from extended-criteria donors and donation after cardiac death. They report that despite being obtained from potentially higher-risk donors, the EVLP donor lungs demonstrated equivalent rates of chronic lung allograft dysfunction and allograft survival at 10-year follow-up. Additionally, at their center, EVLP was associated with a significant increase in the number of transplants during the study period. While there were inherent limitations, such as the retrospective nature of the study, debatable higher-risk status of EVLP lungs, nonrandom assignment of EVLP, and a lack of confounder-adjusted comparison, this study suggests that satisfactory long-term outcomes can be accomplished with EVLP, a valuable contribution. Notably, the system used in this study differs from the commercially available US Food and Drug Administration–approved system in its atrial drainage (closed vs open), and the data presented in this study may not apply to that system.⁵

供体肺可用性有限和等待时间延长仍然是肺移植的主要障碍。根据移植接受者科学注册表，2017年有11％的患者由于死亡或临床恶化而从等待名单中删除，而40％的患者在移植前等待了超过1年。^1个体外肺灌注（EVLP）提供了机会，扩大供体库，但尽管取得了令人鼓舞的早期移植后的结果，^{2 ，3} EVLP的长期效果仍不清楚。在本期《美国医学会杂志》（JAMA Surgery）中，Dithithotawela等人⁴总结了多伦多肺移植集团十年的经验，他们使用了标准温和的EVLP进行了肺部扩张的标准捐献者以及心脏死亡后的捐献。他们报告说，尽管从潜在的较高风险的捐献者那里获得，但EVLP捐献者的肺在10年的随访中表现出同等的慢性肺同种异体移植功能障碍和同种异体移植存活率。此外，在研究期间，以EVLP为中心的移植数量显着增加。尽管存在固有的局限性，例如研究的回顾性，EVLP肺的可争议的高危状态，EVLP的非随机分配以及缺乏混杂因素调整的比较，但这项研究表明可以实现令人满意的长期结果借助EVLP，可做出宝贵的贡献。尤其，⁵