Extended travel for donor organs: Is cold static storage still relevant.

Background: Traditional limitations of cold static storage (CSS) on ice at 4 °C during lung transplantation have necessitated limiting cold ischemic time (CIT) to 4-6 hours. Ex vivo lung perfusion (EVLP) can extend this preservation time through the suspension of CIT and normothermic perfusion. As we continue to further expand the donor pool in all aspects of lung transplantation, teams are frequently traveling further distances to procure organs.

Aim: To determine the effect of CSS or EVLP on donors with extended travel distance [> 750 nautical miles (NM)] to recipient.

Methods: Lung transplants, whose donor traveled greater than 750 NM, were identified from the United Network for Organ Sharing Database. Recipients were stratified into either: CSS or EVLP, based on preservation method. Groups were assessed with comparative statistics and survival was assessed by Kaplan-Meier methods. A 3:1 propensity match was then created, and same analysis was repeated.

Results: Prior to matching, those in the EVLP group had significantly increased post-operative morbidity to include dialysis, ventilator use, acute rejection, and treated rejection in the first year (P < 0.05 for all). However, there were no significant differences in midterm survival (P = 0.18). Following matching, those in the EVLP group again had significantly increased post-operative morbidity to include dialysis, extracorporeal membrane oxygenation use, ventilator use, and treated rejection in the first year (P < 0.05 for all). As before, there were no significant differences in midterm survival following matching (P = 0.08).

Conclusion: While there was no significant difference in survival, EVLP patients had increased peri-operative morbidity. With the advent of changes in CSS with 10 °C storage further analysis is necessary to evaluate the best methods for utilizing organs from increased distances.