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 crossclamp 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 with a cohort of recipients from the previous fifteen months.

Results: In total, 82 transplants were performed at a single academic institution between July 1, 2022, and January 7, 2024, 22% of which included allografts with extended ischemic times using the iceless cooler (n = 18) with a median average temperature of 6.81 °C. 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). Postoperative outcomes were similar between groups, including postoperative intensive care unit duration (12 vs 9 days in the standard group), length of stay (24 vs 20 days), primary graft dysfunction grade (17% vs 20%), postoperative extracorporeal membrane oxygenation (22% vs 20%), and 6-month survival (94% vs 91%).

Conclusions: Donor lungs preserved in an iceless cooler were successfully transplanted after extended cold ischemic times. Adoption of a semielective 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.