Storage with a Novel Donor Lung Preservation System versus Traditional Ice Storage: Comparing Outcomes and Costs
Presented During:
Saturday, May 6, 2023: 10:45AM - 11:00AM
Los Angeles Convention Center
Posted Room Name:
408A
Abstract No:
65
Submission Type:
Abstract Submission
Authors:
Arya Pontula (1), Samantha E. Halpern (2), Brandi A. Bottiger (3), Mary Cooter Wright (3), John Haney (3), Jacob Klapper (4), Matthew Hartwig (5)
Institutions:
(1) University of Manchester, Manchester, UK, (2) Massachusetts General Hospital, Boston, MA, (3) Duke University Medical Center, Durham, NC, (4) Duke University Hospital, Durham, NC, (5) Duke Hospital, Durham, North Carolina
Submitting Author:
Arya Pontula
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University of Manchester
University of Manchester
Co-Author(s):
Samantha E. Halpern
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Massachusetts General Hospital
Massachusetts General Hospital
Brandi A. Bottiger
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Duke University Medical Center
Duke University Medical Center
Mary Cooter Wright
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Duke University Medical Center
Duke University Medical Center
John Haney
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Duke University Medical Center
Duke University Medical Center
*Jacob Klapper
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Duke University Hospital
Duke University Hospital
*Matthew Hartwig
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Duke Hospital
Duke Hospital
Presenting Author:
Arya Pontula
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University of Manchester
University of Manchester
Abstract:
Objective:
A novel hypothermic preservation system (LG) was developed in response to concerns around organ temperature with static ice storage (SIS) for donor lungs in lung transplant (LTx). However, LG is more expensive than SIS and its short-term outcomes in a larger cohort are unclear. Here, we compare short-term outcomes and costs of index hospitalization at a single, high-volume institution between LG recipients and a matched SIS control group.
Methods:
Patients who received lungs stored with LG at our institution were matched 1:1 to a contemporary cohort of patients receiving SIS lungs, based on age at LTx, lung allocation score, disease group, ischemic time, previous LTx, and pre-operative extracorporeal membrane oxygenation (ECMO). Descriptive statistics compared perioperative outcomes and index hospitalization costs between LG and SIS groups.
Results:
In total, 67 LG and 67 matched SIS recipients were included. Cohorts did not differ in age (SIS vs LG: 63.0 vs 62.0 years, p = 0.66), lung allocation score (42.7 vs 41.2, p = 0.61), or proportion of restrictive lung disease (N=50, 74.6% vs N=49, 73.1%). We did not observe differences between groups in donor age, (35.0 vs 34.0 years, p = 0.77), donation after circulatory death (N=11, 16.4% vs N=14, 20.9%, p = 0.66), or ischemic time (7.6 vs 8.0 hours, p = 0.81). The median of average allograft temperatures using the LG device was 5.6°C. Following LTx, LG and SIS recipients had similar rates of grade 3 primary graft dysfunction (PGD) at 72 hours (N=4, 6.0% vs N=9, 13.4%, p = 0.31), acute rejection prior to discharge (N=1, 1.5% vs N=4, 6.0%, p = 0.37), and hospital length of stay (21.0 vs 23.0 days, p = 0.23). LG and SIS recipients had comparable postoperative survival (Figure, p = 0.18). LG and SIS recipients also had similar total direct costs (97300 vs 91900, p = 0.66) and total direct variable costs (85771 vs 80644, p = 0.83) during index hospitalization, with significantly different direct variable costs for respiratory care (7010 vs 2650, p <0.001).
Conclusions:
The LG storage system appears to be an effective alternative for lung preservation compared to SIS, with similar total direct and direct variable costs after LTx as well as similar postoperative survival and perioperative outcomes in the short-term.
Figure. Kaplan-Meier survival analysis of postoperative patient survival among LG and ICE lung transplant recipients.
A novel hypothermic preservation system (LG) was developed in response to concerns around organ temperature with static ice storage (SIS) for donor lungs in lung transplant (LTx). However, LG is more expensive than SIS and its short-term outcomes in a larger cohort are unclear. Here, we compare short-term outcomes and costs of index hospitalization at a single, high-volume institution between LG recipients and a matched SIS control group.
Methods:
Patients who received lungs stored with LG at our institution were matched 1:1 to a contemporary cohort of patients receiving SIS lungs, based on age at LTx, lung allocation score, disease group, ischemic time, previous LTx, and pre-operative extracorporeal membrane oxygenation (ECMO). Descriptive statistics compared perioperative outcomes and index hospitalization costs between LG and SIS groups.
Results:
In total, 67 LG and 67 matched SIS recipients were included. Cohorts did not differ in age (SIS vs LG: 63.0 vs 62.0 years, p = 0.66), lung allocation score (42.7 vs 41.2, p = 0.61), or proportion of restrictive lung disease (N=50, 74.6% vs N=49, 73.1%). We did not observe differences between groups in donor age, (35.0 vs 34.0 years, p = 0.77), donation after circulatory death (N=11, 16.4% vs N=14, 20.9%, p = 0.66), or ischemic time (7.6 vs 8.0 hours, p = 0.81). The median of average allograft temperatures using the LG device was 5.6°C. Following LTx, LG and SIS recipients had similar rates of grade 3 primary graft dysfunction (PGD) at 72 hours (N=4, 6.0% vs N=9, 13.4%, p = 0.31), acute rejection prior to discharge (N=1, 1.5% vs N=4, 6.0%, p = 0.37), and hospital length of stay (21.0 vs 23.0 days, p = 0.23). LG and SIS recipients had comparable postoperative survival (Figure, p = 0.18). LG and SIS recipients also had similar total direct costs (97300 vs 91900, p = 0.66) and total direct variable costs (85771 vs 80644, p = 0.83) during index hospitalization, with significantly different direct variable costs for respiratory care (7010 vs 2650, p <0.001).
Conclusions:
The LG storage system appears to be an effective alternative for lung preservation compared to SIS, with similar total direct and direct variable costs after LTx as well as similar postoperative survival and perioperative outcomes in the short-term.
Figure. Kaplan-Meier survival analysis of postoperative patient survival among LG and ICE lung transplant recipients.
THORACIC:
End Stage Lung Disease and Lung Transplantation
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