Extended travel for donor organs: Is cold static storage still relevant

Area of Science:

• Transplantation research
• Organ preservation techniques
• Surgical outcomes

Background:

• Traditional cold static storage (CSS) limits lung transplant cold ischemic time (CIT) to 4-6 hours.
• Ex vivo lung perfusion (EVLP) extends preservation time by suspending CIT and using normothermic perfusion.
• Increasing organ donor travel distances necessitate evaluating preservation methods.

Purpose of the Study:

• To compare the effects of CSS versus EVLP on lung transplants from donors traveling over 750 nautical miles (NM).
• To assess post-operative morbidity and midterm survival in recipients based on organ preservation method.

Main Methods:

• Retrospective analysis of lung transplants with donor travel > 750 NM from the UNOS database.
• Stratification of recipients into CSS or EVLP groups based on preservation method.
• Comparative statistics and Kaplan-Meier survival analysis, including a 3:1 propensity match.

Main Results:

• Pre-matching: EVLP group showed significantly higher post-operative morbidity (dialysis, ventilator use, rejection) but no difference in midterm survival.
• Post-matching: EVLP group still had significantly higher morbidity (including ECMO use) but maintained similar midterm survival.
• No significant difference in midterm survival was observed between CSS and EVLP groups in either analysis.

Conclusions:

• EVLP did not demonstrate improved midterm survival compared to CSS for long-distance lung transplants.
• EVLP was associated with increased peri-operative morbidity in this patient cohort.
• Further investigation into evolving CSS methods (e.g., 10°C storage) is warranted for optimizing distant organ utilization.