Optimizing Lung Transplant Logistics Using Controlled Hypothermic Preservation to Extend Ischemic Time

Background: Effective organ preservation before transplantation is pivotal for successful outcomes but can be limited by logistics. Organs are primarily preserved by flushing with a cold solution and storing on ice, then transplanted within 8 h of procurement. Controlled hypothermic preservation (CHP) at 4-8 °C has increasingly been used to extend ischemic times. Here we compared early outcomes of transplants using CHP (n = 41) and traditional preservation on ice (n = 41). Methods: Our institution used LUNGguard, a CHP device by Paragonix, for the extension of ischemic time to optimize operating room (OR), transplant team, and recipient logistics. We evaluated 1-y mortality, primary graft dysfunction, length of stay, time to liberation from mechanical ventilation, and time on oxygen support. Results: There were no differences in patient outcomes between storage on ice and CHP. In selected cases, extending ischemic times using CHP allowed for additional organ procurement as well as improved OR logistics. Conclusions: In our experience, CHP has been shown to be a safe and effective method of extending ischemic times in donor lungs, allowing for increased donor acceptance and improved OR efficiency. This supports a growing body of evidence favoring a shift from ice to CHP as the standard for donor lung storage in cases of extended ischemic time.