Extending Cold Ischemic Time Using LUNGguard: A Single Center Experience in Time Shifting.

The LUNGguard Organ Transport System (LG) is an FDA approved device for transporting donor lungs between 4°C - 8°C, mitigating freezing-related cellular and tissue injury. Given recent research on favorable recipient outcomes using LG, we theorized that LG may allow for time-shifting of procedures to the morning to optimize OR and transplant team logistics. The use of LUNGguard for this application in a real-world scenario was evaluated. Beginning April 2022, Houston Methodist Hospital began utilizing LG to extend cold ischemic time (CIT) to the morning hours to improve OR and transplant team logistics. This included preserving OR time for emergency cases and having full daytime staff available at the time of transplantation. At the time of this submission, a total of 10 cases were completed using LG at Houston Methodist Hospital. 7 of these cases utilized LG to shift the case to morning hours. Three time shift cases were double lung transplants (DLT). Three LG cases that were not time shifted were also DLT. Average total ischemic time in time shift cases was 469.4 minutes, and 329.7 minutes in non-time shift cases. Average temperature across time shift cases was 6.1°Celsius, and 5.5°Celsius in non-time shift cases. Average ICU length of stay (LOS) in time shift cases was 7.9 days as compared to 10.3 days in non-time shift cases. Total LOS was 22 days in time shift cases as compared to 65.5 days in the comparator group (not accounting for one patient death during index admission). Days to room air was 8 vs 11.5 days. No primary graft dysfunction (PGD) was diagnosed in cases using LG for time shifting. Our hypothesis that LG can be used to safely time shift cases to the morning hours appears to be supported with this initial evidence. No PGD was detected in time shift cases. ICU LOS, total LOS, time to liberation from oxygen were all found to be shorter in time shift cases. This includes comparing all time shift to non-time shift cases, as well as DLT time shift cases to DLT non-time shift cases. [ABSTRACT FROM AUTHOR]