Cenik Ismail, Van Slambrouck Jan, Barbarossa Annalisa, Vanluyten Cedric, Jin Xin, Prisciandaro Elena, Provoost An-Lies, Vandervelde Christelle M, Novysedlák René, Serçik Ömer, De Leyn Paul, Van Veer Hans, Depypere Lieven, Jansen Yanina, Pirenne Jacques, Van Raemdonck Dirk E, Ceulemans Laurens J
Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.
Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium.
J Heart Lung Transplant. 2025 Mar 19. doi: 10.1016/j.healun.2025.02.1695.
Ischemia-reperfusion injury (IRI) remains an important challenge in lung transplantation (LTx). Ischemia can be divided into 3 phases: cooling during procurement, preservation, and rewarming during implantation. Temperature fluctuations influence metabolic processes, exacerbating IRI. However, actual lung temperatures have not been previously studied. Therefore, we aimed to characterize lung temperature dynamics in clinical LTx for static ice storage (SIS) and controlled hypothermic storage (CHS).
From December 2022 to February 2024, we included 35 SIS and 19 CHS bilateral LTx cases at a single center, resulting in 70 SIS and 38 CHS lungs. Surface temperature (surfaceT°) was measured with a thermography camera. Preservation temperature (preservationT°) was remotely recorded for 6 SIS and 6 CHS. Core temperature (coreT°) was measured with a flexible probe in the lower lobe bronchus after unpacking and every 10 minutes during implantation.
Regarding SIS, mean ± standard deviation (SD) surfaceT° was 30°C ± 3.3°C before flushing, 17°C ± 4.1 °C after extraction, 8.6°C ± 3.3°C before packing. PreservationT° reached 4°C after 98 minutes and 0°C after 266 minutes. After unpacking, surfaceT° was 1.8°C ± 2.3°C, coreT° was 1.6°C ± 1.2°C. At 30 minutes implantation, surfaceT° was 25.0°C ± 2.9°C, coreT° was 22.0°C ± 4.4°C. CHS surfaceT° was 30.0°C ± 2.5°C before flushing, 17°C ± 3.8°C after extraction, and 11°C ± 3.5°C before packing. After unpacking, surfaceT° was 7.9°C ± 2.0°C, and coreT° was 7.1°C ± 1.1°C. At 30 minutes of implantation, surfaceT° was 26.0°C ± 1.7°C, and coreT° was 24.0°C ± 3.6°C. Postoperative outcome was comparable between both groups.
We characterized temperature dynamics in clinical LTx, revealing a rapid temperature drop with pulmonary flushing, potential freezing injury with SIS, and rapid rewarming during implantation.
缺血再灌注损伤（IRI）仍是肺移植（LTx）中的一项重大挑战。缺血可分为三个阶段：获取过程中的降温、保存以及植入过程中的复温。温度波动会影响代谢过程，加剧IRI。然而，此前尚未对实际肺温度进行研究。因此，我们旨在描述临床肺移植中静态冰储存（SIS）和控制性低温储存（CHS）的肺温度动态变化。
2022年12月至2024年2月，我们纳入了单中心35例SIS和19例CHS双侧肺移植病例，共70个SIS肺和38个CHS肺。用热成像仪测量表面温度（surfaceT°）。对6例SIS和6例CHS远程记录保存温度（preservationT°）。拆包后，用柔性探头在下叶支气管测量核心温度（coreT°），植入过程中每10分钟测量一次。
关于SIS，冲洗前平均±标准差（SD）表面温度为30°C±3.3°C，取出后为17°C±4.1°C，包装前为8.6°C±3.3°C。保存温度在98分钟后达到4°C，266分钟后达到0°C。拆包后，表面温度为1.8°C±2.3°C，核心温度为1.6°C±1.2°C。植入30分钟时，表面温度为25.0°C±2.9°C，核心温度为22.0°C±4.4°C。CHS冲洗前表面温度为30.0°C±2.5°C，取出后为17°C±3.8°C，包装前为11°C±3.5°C。拆包后，表面温度为7.9°C±2.0°C，核心温度为7.1°C±1.1°C。植入30分钟时，表面温度为26.0°C±1.7°C，核心温度为24.0°C±3.6°C。两组术后结果相当。
我们描述了临床肺移植中的温度动态变化，揭示了肺冲洗时温度迅速下降、SIS存在潜在冻害以及植入过程中快速复温的情况。
