Saturday, May 6, 2023: 10:45 AM - 11:00 AM
Los Angeles Convention Center
Room: 408A
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.
7 minute presentation; 7 minute discussion