Lung Transplant Outcomes After Implementation Of a Hospital-Based 10C Controlled Hypothermic Organ Preservation Unit.

Objective: Recent work suggests controlled hypothermic preservation (CHP) of lung donor allografts at 10^°C, when compared to standard ice cooler (IC) is associated with improved graft preservation. We hypothesized that clinical outcomes of lung transplant recipients (LTR) with lungs subjected to increased total preservation time (TPT) at 10^OC would be non-inferior.

Methods: Retrospective single center cohort study of consecutive LTRs from Jan 2022 to July 2024, comparing outcomes of LTRs from donor organs exposed to 10^°C CHP versus standard IC. Lungs meeting criteria were procured, transported in IC and either implanted or transferred to 10^°C CHP unit until implantation.

Results: 263 consecutive LTR with 169 in 10^°C cohort and 94 in IC cohort were included. 251 patients (95%) survived to 90 days (161 patients [95%] 10C, 90 patients [96%] IC, p=0.8). Overall median TPT was 7hr 42min, significantly increased in 10^°C cohort (10hr 12min vs. 5hr, p <0.001). TPT range varied from 3hr 2 min to 22hr 49min. When comparing LTRs with TPT over 12hrs (10C Extended) vs. others in 10C cohort (10C Regular) vs. IC, there were no observed differences in PGD at 72hrs (p=0.2), median number of days of ECMO support (p=0.4), duration of mechanical ventilation (p=0.8). Overall survival at one year (n = 236, [90%], p=0.9) revealed no differences.

Conclusions: Extension of total preservation time with a sustainable hospital-based controlled hypothermic preservation unit at 10^°C appears to be safe and non-inferior when compared to standard ice cooler preservation.