Static ice storage has long been the standard-of-care for lung preservation, although freezing injury limits ischemic time (IT). Controlled hypothermic storage (CHS) at elevated temperature could safely extend IT. This retrospective analysis assesses feasibility and safety of CHS with IT > 15 hours. Three lung transplant (LuTx) centers (April-October 2023) included demographics, storage details, IT, and short-term outcome from 13 LuTx recipients (8 male, 59 years old). Donor lungs were preserved in a portable CHS device at 7 (5-9.3)°C. Indication was overnight bridging and/or long-distance transport. IT of second-implanted lung was 17.3 (15.1-22) hours. LuTx were successful, 4/13 exhibited primary graft dysfunction grade 3 within 72 hours and 0/13 at 72 hours. Post-LuTx mechanical ventilation was 29 (7-442) hours. Intensive care unit stay was 9 (5-28) and hospital stay 30 (16-90) days. Four patients needed postoperative extracorporeal membrane oxygenation (ECMO). One patient died (day 7) following malpositioning of an ECMO cannula. This multicenter experience demonstrates the possibility of safely extending IT > 15 hours by CHS.

Department of CHROMETA Laboratory of Respiratory Diseases and Thoracic Surgery BREATHE KU Leuven Leuven Belgium

Department of CHROMETA Laboratory of Respiratory Diseases and Thoracic Surgery BREATHE KU Leuven Leuven Belgium; Department of Respiratory Diseases University Hospitals Leuven Leuven Belgium

Department of Immunology 2nd Faculty of Medicine Charles University and Motol University Hospital Prague Czech Republic

Department of Thoracic Surgery University Hospitals Leuven Leuven Belgium; Department of CHROMETA Laboratory of Respiratory Diseases and Thoracic Surgery BREATHE KU Leuven Leuven Belgium

Department of Thoracic Surgery University Hospitals Leuven Leuven Belgium; Prague Lung Transplant Program 3rd Department of Surgery 1st Faculty of Medicine Charles University and Motol University Hospital Prague Czech Republic; Department of CHROMETA Laboratory of Respiratory Diseases and Thoracic Surgery BREATHE KU Leuven Leuven Belgium

Division of Cardiac Surgery Department of Surgery Massachusetts General Hospital Harvard Medical School Boston Massachusetts

Division of Pulmonary and Critical Care Medicine Department of Medicine Massachusetts General Hospital Harvard Medical School Boston Massachusetts

Prague Lung Transplant Program 3rd Department of Surgery 1st Faculty of Medicine Charles University and Motol University Hospital Prague Czech Republic

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