Extended static preservation of donor lungs at 10°C and early post-transplant outcomes: Experience from a center in the US

INTRODUCTION: An emerging body of evidence suggests that extended static preservation of donor lung allografts at 10°C yields clinical outcomes comparable to standard storage, while enabling transplantation to be performed in a semi-elective manner. We conducted a retrospective analysis to determine whether a mid-sized lung transplant program could replicate outcomes reported in a recent clinical trial and larger transplant centers, while assessing the feasibility and real-world applicability of extended static cold storage. METHODS: We conducted a retrospective single-center study of lung transplants performed between January 1 and December 31, 2025. Recipients were categorized by preservation strategy into standard storage or extended static cold storage at 10°C. Clinical and demographic data were obtained from the electronic health record. The primary outcome was the incidence of primary graft dysfunction (PGD) grades 1 to 3 at 0, 24, 48, and 72 hours following transplantation. Secondary outcomes included duration of mechanical ventilation, length of hospitalization, length of ICU stay, postoperative extracorporeal membrane oxygenation (ECMO) requirement, and 30-day survival. RESULTS: Among 59 lung transplants, 40 underwent extended static cold storage at 10°C and 19 underwent standard preservation. Idiopathic pulmonary fibrosis was the most common indication; 55 of 59 recipients received bilateral lung transplantation. Four cases utilized ex vivo lung perfusion (EVLP) (Lung Bioengineering Inc., Silver Spring, MD, USA). Mean ischemia times were longer in the extended group (right 573.9±237.8 vs 343.5±168.1 min; left 613.8±237.3 vs 364.1±151.2 min). There were no significant between-group differences in PGD at 0, 24, 48, or 72 hours. Length of hospitalization, mechanical ventilation duration, and ICU stay were similar. ECMO was required in 4 (10%) of extended storage cases, but none in standard preservation group. There was no difference in the incidence of PGD based on the donor type (DCD vs DBD), regardless of the extended storage at 10°C. CONCLUSION: Extended static lung preservation at 10 °C was not associated with a statistically significant increase in PGD or adverse short-term clinical outcomes, despite significantly prolonged ischemia times in our cohort. These findings support the feasibility of extended 10 °C preservation without compromising early post-transplant outcomes.