Short-Term Outcomes After Lung Transplantation Using Grafts Preserved at 10 °C: A Single-Centre Study

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OBJECTIVES: Lung transplantation is constrained by donor shortages and logistical challenges. Standard cold storage at 4 °C limits metabolism but can cause cold-induced injury. Preservation at 10 °C may better maintain cellular integrity and extend preservation time. This study evaluated the clinical safety and short-term effectiveness of lung graft preservation at 10 °C within the Italian regulatory framework. METHODS: A single-centre, prospective comparative cohort study included adult recipients of bilateral lung transplantation. The intervention group received lungs transported on ice, preserved overnight at 10 °C, and implanted the following morning. The control group included consecutive recipients with grafts preserved at 4 °C and implanted immediately after arrival. The primary end-point was duration of postoperative mechanical ventilation. Secondary end-points were prolonged ventilation, grade III primary graft dysfunction, need for extracorporeal membrane oxygenation, intensive-care-unit stay, and survival. Inverse probability weighting adjusted for baseline imbalances. RESULTS: Fifty-one patients per group were analysed. The 10 °C cohort had older donors and longer ischaemic times, yet outcomes were comparable: median ventilation 1 (1-3) days vs 2 (1-3) days (P = .167); grade III dysfunction 9.8% vs 21.6% (P = .102); extracorporeal support 19.6% vs 21.6% (P = .807); and median intensive-care-unit stay 4 (3-7) days in both groups (P = .824). Weighted analyses confirmed no significant differences. Survival was similar between groups. CONCLUSIONS: These results support the short-term safety of moderate hypothermic preservation and its potential to improve surgical logistics by enabling daytime procedures. Further multicentre studies are required to confirm long-term outcomes and evaluate its broader clinical applicability. CLINICAL REGISTRATION NUMBER: Milano2 Ethical Committee approved the study with protocol 749_2016bis.

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