Donor lungs cold preservation at 10 °C offers a potential logistic advantage in lung transplantation

Barturen, Mariana Gil; Hernández, Rosalía Laporta; Berrocal, Antonio Romero; Redondo, Marina Pérez; Romero, Ana I.; Carrasco, Susana; Mejía, Lucas Hoyos; Iglesias, Pablo Cordero; Gómez, José Manuel Naranjo; Peláez, M. Córdoba; Antonio, David Gómez de; Cruz, José Luis Campo-Cañaveral de la

doi:10.1016/j.cireng.2022.11.005

Cited by 4 publications

(3 citation statements)

References 6 publications

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“…In this light, extending the time window of implantation by being able to store grafts at 10°C increases flexibility and offers several advantages: (i) scheduled elective cases can be finished by deliberately moving the implantation to the afternoon; (ii) surgically complex recipients can be transplanted during the day when the team can perform at its best, or the most experienced team is available; (iii) small and medium-sized lung transplant centers may be able to accept concurrent donor offers and safely implant the organs one after another. These logistical advantage has already in fact been successfully described by the Madrid transplant program, which accepted two parallel donors and postponed the most complex of the two cases until daytime, thus avoiding parallel surgery in the operating room overnight [ 20 ]. In addition, prolonged organ storage provides the opportunity to optimize a recipient preoperatively.…”

Section: Advantages Of Prolonged Storage At 10°cmentioning

confidence: 99%

The Advent of Semi-Elective Lung Transplantation—Prolonged Static Cold Storage at 10°C

Hoetzenecker,

Benazzo,

Schwarz

et al. 2024

Transpl Int

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Since the early days of clinical lung transplantation the preservation of donor organs has become a fairly standardized procedure and most centers do follow similar processes. This includes the use of low-potassium high dextran flush solutions and static cold storage (SCS) in a cooler filled with ice. Depending on the length of SCS, organs usually arrive at the recipient hospital at a temperature of 0°C–4°C. The question of the optimal storage temperature for donor lung preservation has been revisited as data from large animal experiments demonstrated that organs stored at 10°C experience less mitochondrial damage. Thus, prolonged cold ischemic times can be better tolerated at 10°C—even in pre-damaged organs. The clinical applicability of these findings was demonstrated in an international multi-center observational study including three high-volume lung transplant centers. Total clinical preservation times of up to 24 hrs have been successfully achieved in organs stored at 10°C without hampering primary organ function and short-term outcomes. Currently, a randomized-controlled trial (RCT) is recruiting patients with the aim to compare standard SCS on ice with prolonged SCS protocol at 10°C. If, as anticipated, this RCT confirms data from previous studies, lung transplantation could indeed become a semi-elective procedure.

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Section: Advantages Of Prolonged Storage At 10°cmentioning

confidence: 99%

The Advent of Semi-Elective Lung Transplantation—Prolonged Static Cold Storage at 10°C

Hoetzenecker,

Benazzo,

Schwarz

et al. 2024

Transpl Int

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“…Moreover, preservation on ice is limited to a maximum of 8 h. Therefore, SIS constrains the donor pool and frequently necessitates LTx to be performed overnight under suboptimal working conditions with limited staff. The flaws of SIS have fueled a renewed interest in optimizing donor lung preservation to further improve outcomes after LTx (3)(4)(5)(6)(7)(8)(9)(10). Pioneering animal research in the 1990s, followed by the first recent clinical application in Toronto, showed that controlled hypothermic storage (CHS) at 10°C better preserves mitochondrial integrity (3,4,6,8,(11)(12)(13)(14).…”

Section: Abstract 1 Introductionmentioning

confidence: 99%

Lung transplantation following controlled hypothermic storage with a portable lung preservation device: first multicenter European experience

Provoost,

Novysedlak,

Van Raemdonck

et al. 2024

Front. Cardiovasc. Med.

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IntroductionCompared with traditional static ice storage, controlled hypothermic storage (CHS) at 4–10°C may attenuate cold-induced lung injury between procurement and implantation. In this study, we describe the first European lung transplant (LTx) experience with a portable CHS device.MethodsA prospective observational study was conducted of all consecutively performed LTx following CHS (11 November 2022 and 31 January 2024) at two European high-volume centers. The LUNGguard device was used for CHS. The preservation details, total ischemic time, and early postoperative outcomes are described. The data are presented as median (range: minimum–maximum) values.ResultsA total of 36 patients underwent LTx (i.e., 33 bilateral, 2 single LTx, and 1 lobar). The median age was 61 (15–68) years; 58% of the patients were male; 28% of the transplantations had high-urgency status; and 22% were indicated as donation after circulatory death. In 47% of the patients, extracorporeal membrane oxygenation (ECMO) was used for perioperative support. The indications for using the CHS device were overnight bridging (n = 26), remote procurement (n = 4), rescue allocation (n = 2), logistics (n = 2), feasibility (n = 1), and extended-criteria donor (n = 1). The CHS temperature was 6.5°C (3.7°C–9.3°C). The preservation times were 11 h 18 (2 h 42–17 h 9) and 13 h 40 (4 h 5–19 h 36) for the first and second implanted lungs, respectively, whereas the total ischemic times were 13 h 38 (4 h 51–19 h 44) and 15 h 41 (5 h 54–22 h 48), respectively. The primary graft dysfunction grade 3 (PGD3) incidence rates were 33.3% within 72 h and 2.8% at 72 h. Intensive care unit stay was 8 (4–62) days, and the hospital stay was 28 (13–87) days. At the last follow-up [139 (7–446) days], three patients were still hospitalized. One patient died on postoperative day 7 due to ECMO failure. In-hospital Clavien–Dindo complications of 3b were observed in six (17%) patients, and 4a in seven (19%).ConclusionCHS seems safe and feasible despite the high-risk recipient and donor profiles, as well as extended preservation times. PGD3 at 72 h was observed in 2.8% of the patients. This technology could postpone LTx to daytime working hours. Larger cohorts and longer-term outcomes are required to confirm these observations.

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Section: Abstract 1 Introductionmentioning

confidence: 99%

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Donor lungs cold preservation at 10 °C offers a potential logistic advantage in lung transplantation

Cited by 4 publications

References 6 publications

The Advent of Semi-Elective Lung Transplantation—Prolonged Static Cold Storage at 10°C

The Advent of Semi-Elective Lung Transplantation—Prolonged Static Cold Storage at 10°C

Lung transplantation following controlled hypothermic storage with a portable lung preservation device: first multicenter European experience

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