One-year clinical outcomes of an observational study of static lung preservation at 10° centigrade and semi-elective lung transplantation.

PURPOSE

Lung transplantation (LTx) is performed as soon as donor organs are made available to minimize cold ischemic time. Studies have suggested that an extended static preservation of donor lung allografts at 10°C may offer similar clinical outcomes with the added benefits of surgery being performed as a semi-elective (SE) procedure. The purpose of our study was to compare the clinical outcomes between a cohort of patients who underwent LTx in the traditional fashion and after a period of static preservation at 10°C. Unlike previous studies, we also provide an account of the recipients' pre-transplant health status.

METHODS

This is a prospective, nonrandomized, open label study with propensity matching. Controls were matched using a 2:1 greedy matching algorithm based on LAS within the timeframe of the study (2021-2023), resulting in 15 SE and 30 matched controls. In the SE arm, no LTx was performed between 1800 and 0500 hours. When donor lungs were accepted and the donor cross clamp time occurred between 1800 and 0400 hours, OR time (anesthesia start) was moved to 0600 or later. On arrival, donor lungs were stored at 10°C static preservation. The maximum allowed time between donor cross clamp and recipient anesthesia initiation was 12 hours.

RESULTS

No statistical difference between baseline characteristics was identified between the 2 groups (Table 1). 2/3 of patients were already admitted at the time of transplantation and 15% were on ECMO pre-operatively, indicating a sick patient cohort. Left lung ischemic time (performed second at our institution) was significantly longer in the SE group (722 minutes vs 318 minutes). Post-operative outcomes, including PGD at 72 hours, prolonged MV, ICU and hospital LOS, rejection, re-exploration, and re-admissions were not statistically different between the 2 groups. 1- year survival was 93% for SE patients, and 100% for controls.

CONCLUSION

One-year outcomes of semi-elective lung transplantation is comparable to traditional transplantation recipients, even in a sick cohort of patients.