Prolonged Preservation of up to 24h at 10°C does not Impact Outcomes after Lung Transplantation

Objective: To determine the impact of prolonged storage of donor lungs at 10°C of up to 24h on outcome after lung transplantation.

Background: An increasing body of evidence suggests 10°C as the optimal storage temperature for donor lungs. A recent study showed that cold ischemic times can be safely expanded to >12h when lungs are stored at 10°C. However, it is currently unknown how long donor lungs can be preserved before they deteriorate in function.

Methods: Patients who received a donor lung stored at 10°C between 11/2020 and 06/2023 at the lung transplant programs of Toronto, Vienna and Madrid were included in this retrospective analysis. After excluding EVLP-cases, recipients were grouped based on the total preservation times of their donor organs (<12h: n=48; 12-18h: n=109; ≥18h: n=24). 372 recipients who had received an organ stored on-ice during the study period served as a control group.

Results: Length of lung preservation ranged from 2h 27min to 29h 33min (mean 14h 06min). Despite these prolonged preservation times, early postoperative outcomes were excellent. Median length of mechanical ventilation did not differ between the three study groups (<12h: 41h [IQR 24-109]; 12-18h: 56h [IQR 24-143] and ≥18h: 59h [IQR 28-108]; P=0.493). ICU length of stay (6 d [4-14]; 8 d [4-23]; 8 d [5-32]) and hospital length of stay (32 d [20-48]; 29 d [20-50]; 26 d [17-50]) were also similar. Furthermore, length of donor organ preservation had no impact on patient survival (log rank P=0.413).

Conclusions: Prolonged static preservation of donor lungs at 10°C for up to 24 hours is safe and does not impair short-intermediate outcomes after lung transplantation.