Comparing the Paragonix LUNGguard Donor Lung Preservation System to Traditional Ice Storage

Abstract

Purpose For decades, static cold storage (SCS) has been the standard for preserving donor lungs for transplant (LTx). However, questions and concerns have been raised regarding organ temperature on ice. A new preservation system (Paragonix LUNGguard; LG) was developed to maintain consistent temperatures between 4-8°C. Here, we compare short-term outcomes of recipients using LG for human LTx at a single, high-volume center to a matched SCS control group. Methods Perioperative outcomes for patients who received lungs stored via LG at our institution were collected and matched 1:2 to a contemporary cohort of patients who received lungs stored with SCS. Patients were matched based on age at LTx, lung allocation score, disease group, ischemic time, previous LTx, and pre-operative ECMO. Descriptive statistics compared perioperative outcomes between LG and SCS groups. Results 18 LG and 36 matched SCS recipients were included. Age (LG vs SCS: 61.5 vs 62.0 years, p = 0.65), lung allocation score (41.9 vs 43.6, p = 0.73), and proportion of restrictive lung disease (14, 77.8% vs 28, 77.8%, p = 1.00) were similar for recipients between cohorts. Donor age (32.0 vs 34.0 years, p = 0.67), PaO2/FiO2 ratio (423 vs 475, p = 0.24), and proportion of donation after circulatory death (3, 16.7% vs 7, 19.4%, p = 1.00) were also similar between cohorts. Median ischemic time did not differ significantly between cohorts (394 vs 395 minutes, p = 0.84). With the LG device, the median of the average allograft storage temperatures was 4.7°C (range: -0.4 - 6.1°C). During the index transplant hospitalization, LG and SCS recipients had similar rates of acute rejection (3, 16.7% vs 1, 2.8%, p = 0.10). Rates of any grade 3 primary graft dysfunction (PGD3) within 72 hours post-transplant (7, 38.9% vs 14, 38.9%, p = 1.00), PGD3 at 48 or 72 hours (3, 16.7% vs 7, 19.4%, p = 1.00), postoperative ECMO (4, 22.2% vs 6, 16.7%, p = 0.72), hospital length of stay (30.0 vs 29.0 days, p = 0.81), and 90-day mortality (1, 2.8% vs 1, 5.6%, p = 1.00) were similar between cohorts. Conclusion Compared to traditional cold storage, the LG storage system appears to be an effective alternative for lung preservation, with similar short-term perioperative outcomes after LTx. For decades, static cold storage (SCS) has been the standard for preserving donor lungs for transplant (LTx). However, questions and concerns have been raised regarding organ temperature on ice. A new preservation system (Paragonix LUNGguard; LG) was developed to maintain consistent temperatures between 4-8°C. Here, we compare short-term outcomes of recipients using LG for human LTx at a single, high-volume center to a matched SCS control group. Perioperative outcomes for patients who received lungs stored via LG at our institution were collected and matched 1:2 to a contemporary cohort of patients who received lungs stored with SCS. Patients were matched based on age at LTx, lung allocation score, disease group, ischemic time, previous LTx, and pre-operative ECMO. Descriptive statistics compared perioperative outcomes between LG and SCS groups. 18 LG and 36 matched SCS recipients were included. Age (LG vs SCS: 61.5 vs 62.0 years, p = 0.65), lung allocation score (41.9 vs 43.6, p = 0.73), and proportion of restrictive lung disease (14, 77.8% vs 28, 77.8%, p = 1.00) were similar for recipients between cohorts. Donor age (32.0 vs 34.0 years, p = 0.67), PaO2/FiO2 ratio (423 vs 475, p = 0.24), and proportion of donation after circulatory death (3, 16.7% vs 7, 19.4%, p = 1.00) were also similar between cohorts. Median ischemic time did not differ significantly between cohorts (394 vs 395 minutes, p = 0.84). With the LG device, the median of the average allograft storage temperatures was 4.7°C (range: -0.4 - 6.1°C). During the index transplant hospitalization, LG and SCS recipients had similar rates of acute rejection (3, 16.7% vs 1, 2.8%, p = 0.10). Rates of any grade 3 primary graft dysfunction (PGD3) within 72 hours post-transplant (7, 38.9% vs 14, 38.9%, p = 1.00), PGD3 at 48 or 72 hours (3, 16.7% vs 7, 19.4%, p = 1.00), postoperative ECMO (4, 22.2% vs 6, 16.7%, p = 0.72), hospital length of stay (30.0 vs 29.0 days, p = 0.81), and 90-day mortality (1, 2.8% vs 1, 5.6%, p = 1.00) were similar between cohorts. Compared to traditional cold storage, the LG storage system appears to be an effective alternative for lung preservation, with similar short-term perioperative outcomes after LTx.