Lung transplant outcomes after implementation of a hospital-based 10 °C controlled hypothermic organ preservation unit.

Abstract

Recent work suggests controlled hypothermic preservation (CHP) of lung donor allografts at 10 °C, when compared with standard ice cooler (IC), is associated with improved graft preservation. We hypothesized that clinical outcomes of lung transplant recipients (LTRs) with lungs subjected to increased total preservation time (TPT) at 10 °C would be noninferior. This was a retrospective, single-center cohort study of consecutive LTRs from January 2022 to July 2024 in which we compared outcomes of LTRs from donor organs exposed to 10 °C CHP versus standard IC. Lungs meeting criteria were procured, transported in IC, and either implanted or transferred to 10 °C CHP unit until implantation. In total, 263 consecutive LTRs with 169 in the 10 °C cohort and 94 in the IC cohort were included; 251 patients (95%) survived to 90 days (161 patients [95%] 10 °C, 90 patients [96%] IC, P = .8). Overall median TPT was 7 hours, 42 minutes, significantly increased in 10 °C cohort (10 hours, 12 minutes vs 5 hours, P < .001). TPT range varied from 3 hours, 2 minutes to 22 hours, 49 minutes. When comparing LTRs with TPT over 12 hours (10 °C extended) versus others in the 10 °C cohort (10 °C regular) versus IC, there were no observed differences in primary graft dysfunction at 72 hours (P = .2), median number of days of extracorporeal membrane oxygenation support (P = .4), or duration of mechanical ventilation (P = .8). Overall survival at 1 year (n = 236, [90%], P = .9) revealed no differences. Extension of total preservation time with a sustainable hospital-based controlled hypothermic preservation unit at 10 °C appears to be safe and noninferior when compared with standard ice cooler preservation.