We tested the association between ABO blood type and recovery rate of suboptimal donor lungs for transplantation in a prospective cohort of donor lungs treated with EVLP as part of the 6-center NOVEL lung trial (73). In the NOVEL lung trial, EVLP was considered if the donor lungs had evidence of acute lung injury. Specifically, donor lungs demonstrated a PaO2/FiO2 less than or equal to 300 mmHg or a PaO2/FiO2 greater than 300 mmHg, but the donor had any of the following risk factors: multiple blood transfusions, pulmonary edema, donation after cardiac death, or the investigator deemed the donor lung quality as poor. Donor lungs with chronic lung disease, pneumonia, gastric acid aspiration, or significant barotrauma were excluded. After procurement, donor lungs were placed in a cold preservation solution and transported to a study site. Lung grafts were then placed on a mechanical ventilator and EVLP perfusion circuit and rewarmed. Lungs were perfused with an acellular perfusate, including balanced electrolytes and protein. EVLP was maintained for 4 hours and the grafts underwent serial assessments for improvement in physiological parameters. Once placed on EVLP, lungs were considered transplantable if they had 2 consecutive PaO2 greater than 350 on 100% FiO2 and had stable or improving pulmonary vascular resistance, compliance, and airway pressure. EVLP cases were performed on the XVIVO Perfusion System platform. ABO blood type was determined for each lung by blood bank typing of the donor because genetically determined ABO blood type was unavailable.

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