Not Too Warm, Not Too Cold: Real-World Multi-Center Outcomes with Elevated Hypothermic Preservation of Donor Lungs

PurposeRecent reports highlight the potential clinical improvements from hypothermic preservation at elevated temperatures of donor lungs, avoiding risk of mitochondrial injury with standard ice storage (ICE) where lungs reach temperatures near or below 0°C. LUNGguard Donor Lung Preservation System (LG) is the only FDA and CE cleared preservation technology which maintains donor lungs at elevated hypothermic temperatures, potentially mitigating temperature-related tissue injury. Real-world experience of this preservation strategy on recipient outcomes is presented.MethodsThe GUARDIAN Lung Registry is a multicenter registry assessing outcomes following lung transplants comparing LG and ICE. Retrospective review of clinical outcomes was examined using excel summary statistics and survival analysis using GraphPad Prism v 9.0.ResultsTransplants in patients using LG (n=86) vs ICE (n=90) had similar baseline characteristics except significantly more LG-preserved lungs were retrieved from DCD donors (17.6% v 6.7% ICE, p = 0.025, Table). LG cohort had a clinically meaningful 54% reduction in primary graft dysfunction at 72 hours (p=0.058). LG was also associated with significantly improved one year Kaplan Meier estimated survival 92.7% vs 82.2%, p=0.02 (Figure).ConclusionUse of LUNGguard is associated with a reduction in PGD3 and enhanced 1-year survival compared to ICE. These data support growing evidence that avoiding donor lung cold or near-freezing injury through elevated hypothermic preservation has a meaningful impact on outcomes. Recent reports highlight the potential clinical improvements from hypothermic preservation at elevated temperatures of donor lungs, avoiding risk of mitochondrial injury with standard ice storage (ICE) where lungs reach temperatures near or below 0°C. LUNGguard Donor Lung Preservation System (LG) is the only FDA and CE cleared preservation technology which maintains donor lungs at elevated hypothermic temperatures, potentially mitigating temperature-related tissue injury. Real-world experience of this preservation strategy on recipient outcomes is presented. The GUARDIAN Lung Registry is a multicenter registry assessing outcomes following lung transplants comparing LG and ICE. Retrospective review of clinical outcomes was examined using excel summary statistics and survival analysis using GraphPad Prism v 9.0. Transplants in patients using LG (n=86) vs ICE (n=90) had similar baseline characteristics except significantly more LG-preserved lungs were retrieved from DCD donors (17.6% v 6.7% ICE, p = 0.025, Table). LG cohort had a clinically meaningful 54% reduction in primary graft dysfunction at 72 hours (p=0.058). LG was also associated with significantly improved one year Kaplan Meier estimated survival 92.7% vs 82.2%, p=0.02 (Figure). Use of LUNGguard is associated with a reduction in PGD3 and enhanced 1-year survival compared to ICE. These data support growing evidence that avoiding donor lung cold or near-freezing injury through elevated hypothermic preservation has a meaningful impact on outcomes.