AUTHOR=Provoost An-Lies , Novysedlak Rene , Van Raemdonck Dirk , Van Slambrouck Jan , Prisciandaro Elena , Vandervelde Christelle M. , Barbarossa Annalisa , Jin Xin , Denaux Karen , De Leyn Paul , Van Veer Hans , Depypere Lieven , Jansen Yanina , Pirenne Jacques , Neyrinck Arne , Bouneb Sofian , Ingels Catherine , Jacobs Bart , Godinas Laurent , De Sadeleer Laurens , Vos Robin , Svorcova Monika , Vajter Jaromir , Kolarik Jan , Tavandzis Janis , Havlin Jan , Ozaniak Strizova Zuzana , Pozniak Jiri , Simonek Jan , Vachtenheim Jiri , Lischke Robert , Ceulemans Laurens J. 

TITLE=Lung transplantation following controlled hypothermic storage with a portable lung preservation device: first multicenter European experience

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 11 - 2024

YEAR=2024

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2024.1370543

DOI=10.3389/fcvm.2024.1370543

ISSN=2297-055X

ABSTRACT=Introduction: Compared to traditional static ice storage (SIS), controlled hypothermic storage (CHS) at 4-10°C may attenuate cold-induced lung injury between procurement and implantation.Herein we describe the first European lung transplant (LTx) experience with a portable CHS device.Methods: A prospective observational study was conducted of all consecutively performed LTx following CHS (November 11 th 2022 and January 31 st 2024) at two European high-volume centers.The LUNGguard (Paragonix) device was used for CHS. Preservation details, total ischemic time, and early postoperative outcomes are described. Data are presented as median (range: minimummaximum).Results: Thirty-six patients underwent lung transplantation (LTx): 33 bilateral, 2 single, and 1 lobar. Age was 61 (15-68) years, 58% were male, 28% high-urgency status, and 22% donation after circulatory death. In 47% extracorporeal membrane oxygenation (ECMO) was used for perioperative support. Indications for using the CHS device were overnight bridging (n=26), remote procurement (n=4), rescue allocation (n=2), logistics (n=2), feasibility (n=1), and extendedcriteria donor (n=1). CHS temperature was 6.5 (3.7-9.3) °C. Preservation time was 11h18 (02h42-17h09) and 13h40 (04h05-19h36) for the first and second implanted lung, respectively, whereas total ischemic time was 13h38 (04h51-19h44) and 15h41 (05h54-22h48). Primary graft dysfunction grade 3 (PGD3) incidence was 33.3% within 72h, and 2.8% at 72h. Intensive care unit stay was 8 (4-62) days and hospital stay 28 (13-87) days. At last follow-up (139 (7-446) days) 3 patients were still hospitalized. One patient died at postoperative day 7 due to ECMO-failure. Inhospital Clavien-Dindo complications of 3b were observed in 6 (17%) patients, and 4a in 7 (19%).CHS seems safe and feasible despite high-risk recipient and donor profile, as well as extended preservation times. PGD3 at 72h was observed in 2.8%. This technology could postpone LTx to daytime working hours. Larger cohorts and longer-term outcome are required to confirm these observations.