Initial Case Series with a Novel Cold Storage System for Lung Transplantation

Abstract

<h3>Purpose</h3> Hypothermia is used to slow the metabolic rate and degradation of donor organs. However, the most commonly used method, ice storage, assures neither a uniform nor an optimal preservation temperature for the organ. Although a recent report suggests that 10 ºC storage prolongs cellular preservation and prevents grade 3 primary graft dysfunction (PGD) in lungs transplanted following <i>ex vivo</i> lung perfusion assessment, these resources are not available at all centers. We report an early case series with a new FDA-approved device that provides temperature-regulated 4 ºC transport of donor lungs and an 8-hour storage time. <h3>Methods</h3> We retrospectively examined the outcomes of 9 patients who underwent bilateral lung transplantation over a 4-month period at our institution. Three patients received donor lungs transported using the novel preservation device (novel group), while 6 patients received donor lungs preserved in ice (standard group). PGD at 24, 48, and 72 hours was the primary outcome. Secondary outcomes included post-reperfusion P/F ratios, ventilation hours, days in ICU, length of stay (LOS), and death. <h3>Results</h3> The standard group recipients were older than the patients in the novel group (standard 64.0 ± 2.4 vs novel 59.3 ± 1.2 years, p = 0.004). Donor characteristics were similar between the two groups. There were no differences in either the total (397.5 ± 59.0 vs 352.7 ± 27.0 minutes, p = 0.16) or warm (46.9 ± 15.3 vs 45.0 ± 13.5 minutes, p = 0.79) ischemic times. Ten minutes after reperfusion, the median intraoperative P/F ratio was markedly better in the novel group (432.4, IQR 341.9-516.2) than the standard group (243.2, IQR 190.2-363.9). No PGD was observed in the novel group. In the standard group, grade 2 or 3 PGD was seen in 4 patients after 24 hours, 2 patients after 48 hours, and 3 patients after 72 hours. The novel group had a shorter LOS (38.0 ± 16.2 vs 16.3 ± 6.1 days, p = 0.04). There was 1 death in the standard ice group and no deaths in the novel device group (<i>n.s.</i>). <h3>Conclusion</h3> The novel preservation system regulates the temperature of donor lungs during transport and until implantation. Our early experience suggests that the novel device may minimize PGD, improve post-reperfusion P/F ratios, and shorten LOS. Analysis of larger cohorts in a randomized controlled study is recommended to validate these results.