65. Storage with a Novel Donor Lung Preservation System versus Traditional Ice Storage: Comparing Outcomes and Costs
Medical University of Vienna
Vienna, CA
Austria - Contact Me
Konrad Hoetzenecker, MD PhD is a member of the surgical faculty of the Department of Thoracic Surgery, Medical University of Vienna, and the Director of the Vienna Lung Transplant Program. Besides lung transplantation he is specialized in airway surgery and extended thoracic procedures. Dr Hoetzenecker has authored numerous peer-reviewed articles and is an editorial board member of the Journal of Thoracic and Cardiovascular Surgery and the Journal of Heart and Lung Transplantation. Dr Hoetzenecker has been awarded several prizes and grants including the Graham Memorial Traveling Fellowship from the American Association of Thoracic Surgery.
University of Manchester
Manchester, UK
United Kingdom - Contact Me
Arya Pontula is a research fellow within the Duke University Department of Surgery and Duke Ex-Vivo Organ Laboratory and a third-year medical student at the University of Manchester Medical School. She is interested in investigating clinical outcomes of lung transplantation and passionate about using this research to improve clinical practice.
Abstract
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.