Thoracic Surgery and Lung Transplantation Department, Hospital Universitario Puerta de Hierro-Majadahonda, Spain.
Pneumology Department, Hospital Universitario Puerta de Hierro-Majadahonda, Spain.
Arch Bronconeumol. 2024 Jun;60(6):336-343. doi: 10.1016/j.arbres.2024.03.021. Epub 2024 Apr 6.
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.
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 graft dysfunction (PGD) grade-3 at 72-h. Secondary endpoints: clinical outcomes, cytokine profile and logistical impact.
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).
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.
在 10°C 下进行冷静态供体肺保存似乎是一种有前途的方法，可以安全地延长冷缺血时间 (CIT) 并改善肺移植 (LTx) 的物流。
本研究为单中心、前瞻性、非随机研究，纳入 2021 年 11 月至 2023 年 2 月期间的 LTx，比较了在 10°C 下进行长时间保存与在冰上进行标准保存的效果。10°C 保存的纳入标准为适合进行 LTx 的供体肺，且不存在任何供体获取方面的问题。
72 小时时的原发性移植物功能障碍 (PGD) 分级 3。次要终点：临床结果、细胞因子谱和物流影响。
57 例中有 33 例在 10°C 下进行了保存。两组的供体和受体特征相似。10°C 组的总保存时间（小时:分钟）较长（p<0.001）[第一肺：中位数 12:09（IQR 9:23-13:29）；第二肺：14:24（12:00-16:20）]，而标准组[第一肺：中位数 5:47（IQR 5:18-6:40）；第二肺：7:15（6:33-7:40）]。72 小时时的 PGD 分级 3 在 10°C 组为 9.4%，在标准组为 12.5%（p=0.440）。两组的机械通气（MV）时间、重症监护病房和住院时间相似。10°C 组的 30 天和 90 天死亡率为 0%（标准组为 4.2%）。标准组在移植后 6 小时的白细胞介素-8 浓度明显升高（p=0.025），而 10°C 组在移植后 72 小时的白细胞介素-10 浓度升高（p=0.045）。
在 10°C 下进行保存可能是一种安全且可行的策略，可以有意延长 CIT。在我们中心，在 10°C 下延长 CIT 时间可能允许进行半择期 LTx，并改善物流，与当前的冰上标准保存相比，具有相似的结果。
