Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.
Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium.
Transpl Int. 2024 Apr 17;37:12601. doi: 10.3389/ti.2024.12601. eCollection 2024.
Controlled hypothermic storage (CHS) is a recent advance in lung transplantation (LTx) allowing preservation at temperatures higher than those achieved with traditional ice storage. The mechanisms explaining the benefits of CHS compared to conventional static ice storage (SIS) remain unclear and clinical data on safety and feasibility of lung CHS are limited. Therefore, we aimed to provide a focus review on animal experiments, molecular mechanisms, CHS devices, current clinical experience, and potential future benefits of CHS. Rabbit, canine and porcine experiments showed superior lung physiology after prolonged storage at 10°C vs. ≤4°C. In recent molecular analyses of lung CHS, better protection of mitochondrial health and higher levels of antioxidative metabolites were observed. The acquired insights into the underlying mechanisms and development of CHS devices allowed clinical application and research using CHS for lung preservation. The initial findings are promising; however, further data collection and analysis are required to draw more robust conclusions. Extended lung preservation with CHS may provide benefits to both recipients and healthcare personnel. Reduced time pressure between procurement and transplantation introduces flexibility allowing better decision-making and overnight bridging by delaying transplantation to daytime without compromising outcome.
控制性低温保存（CHS）是肺移植（LTx）领域的一项最新进展，它允许在高于传统冰保存温度下进行保存。与传统的静态冰保存（SIS）相比，CHS 带来益处的机制尚不清楚，且关于肺 CHS 的安全性和可行性的临床数据有限。因此，我们旨在提供对动物实验、分子机制、CHS 设备、当前临床经验和 CHS 潜在未来获益的重点综述。兔、犬和猪的实验表明，在 10°C 下长时间储存比在 ≤4°C 下储存可获得更好的肺生理功能。在最近对肺 CHS 的分子分析中，观察到线粒体健康的更好保护和更高水平的抗氧化代谢物。对潜在机制和 CHS 设备的开发的深入了解，允许了使用 CHS 进行肺保存的临床应用和研究。初步发现是有希望的；然而，需要进一步的数据收集和分析来得出更可靠的结论。使用 CHS 进行延长的肺保存可能对受者和医疗保健人员都有益处。在采购和移植之间减少时间压力，为更好的决策和通过推迟到白天进行移植来隔夜桥接提供了灵活性，而不会影响结果。
