Controlled-temperature preservation: overcoming the timing challenge in uncontrolled donation after circulatory death lung transplantation.

Le résumé fourni par la source

Preserving donor lungs at 10°C is an emerging technique with the potential to extend cold ischemia time without compromising recipient outcomes. This approach could be particularly beneficial in uncontrolled donation after circulatory death (uDCD). We report our early experience with 10°C lung preservation after ex vivo lung perfusion (EVLP) following uDCD donation. We conducted a pilot study on consecutive bilateral lung transplants utilizing 10°C graft preservation, June-December 2024. Lungs from uDCD donors were retrieved following standard open-lung normothermic ventilation and transported in ice-filled coolers. Upon arrival, they underwent EVLP and then transferred to 10°C incubator until implantation, routinely scheduled for the following morning. Key outcomes included grade 3 primary graft dysfunction (PGD) at 72 hours, postoperative invasive ventilation (IV) duration, and intensive care unit length of stay (ICU-LOS). 3 transplant recipients were enrolled (COPD F 58 years; IPF F 63y; bronchiectasis M 61y). The duration of preservation at 10°C after EVLP was extended for mean of 15.04 hours (range: 9.38–23.38), with a total cold ischemia time of 1069.7 minutes (range: 780–1502). All recipients had uneventful postoperative course, with mean IV duration of 1.3 days (range: 1–2), mean ICU-LOS of 3.3 days (range: 3–4), no cases of 72h PGD. This prospective pilot study demonstrates the feasibility of prolonged 10°C graft preservation in real-world setting, allowing for better timing control without compromising short-term outcomes. Hypothermic storage could serve as powerful tool to manage the logistical issues inherent to the uDCD setting.

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