Extended ischemic time (>15 hours) using controlled hypothermic storage in lung transplantation: A multicenter experience

Static ice storage has long been the standard-of-care for lung preservation, although freezing injury limits ischemic time (IT). Controlled hypothermic storage (CHS) at elevated temperature could safely extend IT. This retrospective analysis assesses feasibility and safety of CHS with IT>15h. Three lung transplant (LuTx) centers (April-October 2023) included demographics, storage details, IT and short-term outcome from 13 LuTx recipients (8 male, 59 years old). Donor lungs were preserved in a portable CHS-device at 7(5-9.3)°C. Indication was overnight bridging and/or long-distance transport. IT of second-implanted lung was 17.3(15.1-22)h. LuTx were successful, 4/13 exhibited primary graft dysfunction grade 3 within 72h and 0/13 at 72h. Post-LuTx mechanical ventilation was 29(7-442)h. Intensive care unit stay was 9(5-28) and hospital stay 30(16-90) days. Four patients needed post-operative extracorporeal membrane oxygenation (ECMO). One patient died (day seven) following malpositioning of an ECMO cannula. This multi-center experience demonstrates the possibility of safely extending IT>15h by CHS.