Revisiting optimal static lung preservation techniques in an era when machine perfusion is transforming organ...

Recent initiatives have led to outstanding increases in lung procurement employing donation after circulatory death (DCD) and transplantation of DCD lungs. Although this shift to expand donor resources is encouraging, outcomes after lung transplantation, particularly after DCD lung transplantation, have lagged behind the notable success seen for transplantation of abdominal organs such as kidneys and livers. Additionally, improvements through the use of machine perfusion (MP) in lung transplantation protocols have not been as clearly appreciated or consistently demonstrated as in abdominal organ transplantation. The lungs are uniquely sensitive to perfusion, as compared with kidneys and livers, due to their distinct organ biology. Thus, refining static organ-preservation techniques without perfusion may be more successful in improving outcomes than trying to replicate the success of continuous MP in abdominal organ procurement. Focusing on optimizing temperature-based protocols for lung procurement may be particularly helpful. In this review, we posit that temperature-based refinement is necessary to optimize static lung preservation techniques. Precise thermoregulation may lead to better outcomes after lung transplantation, especially with DCD lungs. This novel thermoregulation concept is based on previously published basic science studies on organ bio-physiology inherent to the lungs, clinical studies, and key differences between the lungs and other organs.