Frontiers in Cardiovascular Medicine (Jun 2024)

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

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

DOI
https://doi.org/10.3389/fcvm.2024.1370543
Journal volume & issue
Vol. 11

Abstract

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IntroductionCompared with traditional static ice storage, controlled hypothermic storage (CHS) at 4–10°C may attenuate cold-induced lung injury between procurement and implantation. In this study, we describe the first European lung transplant (LTx) experience with a portable CHS device.MethodsA prospective observational study was conducted of all consecutively performed LTx following CHS (11 November 2022 and 31 January 2024) at two European high-volume centers. The LUNGguard device was used for CHS. The preservation details, total ischemic time, and early postoperative outcomes are described. The data are presented as median (range: minimum–maximum) values.ResultsA total of 36 patients underwent LTx (i.e., 33 bilateral, 2 single LTx, and 1 lobar). The median age was 61 (15–68) years; 58% of the patients were male; 28% of the transplantations had high-urgency status; and 22% were indicated as donation after circulatory death. In 47% of the patients, extracorporeal membrane oxygenation (ECMO) was used for perioperative support. The 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 extended-criteria donor (n = 1). The CHS temperature was 6.5°C (3.7°C–9.3°C). The preservation times were 11 h 18 (2 h 42–17 h 9) and 13 h 40 (4 h 5–19 h 36) for the first and second implanted lungs, respectively, whereas the total ischemic times were 13 h 38 (4 h 51–19 h 44) and 15 h 41 (5 h 54–22 h 48), respectively. The primary graft dysfunction grade 3 (PGD3) incidence rates were 33.3% within 72 h and 2.8% at 72 h. Intensive care unit stay was 8 (4–62) days, and the hospital stay was 28 (13–87) days. At the last follow-up [139 (7–446) days], three patients were still hospitalized. One patient died on postoperative day 7 due to ECMO failure. In-hospital Clavien–Dindo complications of 3b were observed in six (17%) patients, and 4a in seven (19%).ConclusionCHS seems safe and feasible despite the high-risk recipient and donor profiles, as well as extended preservation times. PGD3 at 72 h was observed in 2.8% of the patients. This technology could postpone LTx to daytime working hours. Larger cohorts and longer-term outcomes are required to confirm these observations.

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