Donor Lung Preservation at 10°C: Clinical and Logistical Impact

Arch Bronconeumol. 2024 Jun;60(6):336-343. doi: 10.1016/j.arbres.2024.03.021. Epub 2024 Apr 6.
[Article in English, Spanish]

Abstract

Introduction: Cold static donor lung preservation at 10°C appears to be a promising method to safely extend the cold ischemic time (CIT) and improve lung transplant (LTx) logistics.

Methods: LTx from November 2021 to February 2023 were included in this single institution, prospective, non-randomized study comparing prolonged preservation at 10°C versus standard preservation on ice. The inclusion criteria for 10°C preservation were suitable grafts for LTx without any donor retrieval concerns.

Primary endpoint: primary graft dysfunction (PGD) grade-3 at 72-h. Secondary endpoints: clinical outcomes, cytokine profile and logistical impact.

Results: Thirty-three out of fifty-seven cases were preserved at 10°C. Donor and recipient characteristics were similar across the groups. Total preservation times (h:min) were longer (p<0.001) in the 10°C group [1st lung: median 12:09 (IQR 9:23-13:29); 2nd: 14:24 (12:00-16:20)] vs. standard group [1st lung: median 5:47 (IQR 5:18-6:40); 2nd: 7:15 (6:33-7:40)]. PGD grade-3 at 72-h was 9.4% in 10°C group vs. 12.5% in standard group (p=0.440). Length of mechanical ventilation (MV), ICU and hospital stays were similar in both groups. Thirty and ninety-day mortality rates were 0% in 10°C group (vs. 4.2% in standard group). IL-8 concentration was significantly higher 6-h post-LTx in the standard group (p=0.025) and IL-10 concentration was increased 72-h post-LTx in the 10°C group (p=0.045).

Conclusions: Preservation at 10°C may represent a safe and feasible strategy to intentionally prolong the CIT. In our center, extending the CIT at 10°C may allow for semi-elective LTx and improve logistics with similar outcomes compared to the current standard preservation on ice.

Keywords: 10°C cold storage; Cytokines; Donor lung preservation; Logistics; Lung transplantation; Prolonged static cold preservation.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Cold Ischemia
  • Cytokines / blood
  • Female
  • Humans
  • Interleukin-10 / blood
  • Interleukin-8 / analysis
  • Interleukin-8 / blood
  • Length of Stay / statistics & numerical data
  • Lung
  • Lung Transplantation*
  • Male
  • Middle Aged
  • Organ Preservation* / methods
  • Primary Graft Dysfunction* / prevention & control
  • Prospective Studies
  • Respiration, Artificial
  • Time Factors
  • Tissue Donors

Substances

  • Interleukin-8
  • Interleukin-10
  • Cytokines
  • CXCL8 protein, human