Adoption of a Semi-elective Lung Transplantation Practice by Safely Extending Cold Ischemic Times.

Objective: Lung transplantation is a complex surgical procedure performed by specialized teams. Practice changes to eliminate overnight lung transplants were implemented at our center and patient outcomes were evaluated.

Methods: Patient and donor organ selection were performed in the standard fashion. All donors with a cross clamp after 6 PM matched to any of our listed recipients-independent of their surgical complexity or risk-were kept in a temperature-controlled iceless cooler from procurement to recipient implant. All recipients had a 7 AM in-room start. Data were prospectively collected and compared to a cohort of recipients from the previous fifteen months.

Results: 82 transplants were performed at a single academic institution between 7/1/22 and 1/7/24, 21% of which included allografts with extended ischemic times utilizing the iceless cooler (n=18) with a median average temperature of 6.81 degrees Celsius. Median ischemic times were 13.9 (12.5 - 15.6) hours, more than twice the length of ischemic times in the standard group (n=64, 6.8 (6.1 - 7.4) hours). Post-operative outcomes were similar between groups, including post-operative ICU duration (12 vs 9 days in the standard group), length of stay (24 vs 20 days), PGD3 (17% vs 20%), post-operative ECMO (22% vs 20%), and six-month survival (94% vs 91%).

Conclusions: Donor lungs preserved in an iceless cooler were successfully transplanted after extended cold ischemic times. Adoption of a semi-elective transplant strategy can be successfully implemented without compromising patient outcomes. Additional advantages may be gleaned through daytime transplantation with standard transplant surgical teams rather than overnight, on call-teams.