A comparison of contemporary donor lung preservation strategies: ice vs portable ex vivo lung perfusion vs controlled hypothermic storage.

Abstract

Advanced donor lung preservation strategies such as portable ex vivo lung perfusion (pEVLP) and controlled hypothermic storage at 4-8^oC (CHS) have revolutionized the practice of lung transplantation, allowing for prolonged preservation and expansion of the donor pool compared to ice. However, it remains unclear how to integrate different strategies in the modern era, especially the role of pEVLP vs CHS. We reviewed all adult lung transplants performed at our institution from January 2016 to January 2025, excluding multiorgan transplants. Patients were grouped by preservation method: ice (n=282), pEVLP (n=139), or CHS (n=76). We compared perioperative outcomes across the three strategies. Subanalyses were performed comparing pEVLP to CHS in cases of extended criteria donor lungs and prolonged preservation times (out of body time >8 hrs). The pEVLP and CHS groups had higher risk recipient and donor characteristics compared to ice. There was no difference in primary graft dysfunction grade 3 at 48-72 hrs among groups, but there was a higher incidence of postoperative extracorporeal membrane oxygenation and prolonged ventilator support in the pEVLP and CHS groups. However, in multivariable logistic regression, preservation strategy was not associated with allograft graft dysfunction despite significantly longer preservation times. Overall, pEVLP and CHS achieved similar outcomes to ice despite significantly longer preservation times. Accordingly, pEVLP and CHS both represent viable strategies to expand the donor pool and enable extended preservation times.