Temperature dynamics of donor lungs from procurement to reperfusion: Static ice versus controlled hypothermic storage

Abstract

BACKGROUND: Ischemia-reperfusion injury (IRI) remains an important challenge in lung transplantation (LTx). Ischemia can be divided into 3 phases: cooling during procurement, preservation, and rewarming during implantation. Temperature fluctuations influence metabolic processes, exacerbating IRI. However, actual lung temperatures have not been previously studied. Therefore, we aimed to characterize lung temperature dynamics in clinical LTx for static ice storage (SIS) and controlled hypothermic storage (CHS). METHODS: From December 2022 to February 2024, we included 35 SIS and 19 CHS bilateral LTx cases at a single center, resulting in 70 SIS and 38 CHS lungs. Surface temperature (surfaceT degrees) was measured with a thermography camera. Preservation temperature (preservationT degrees) was remotely recorded for 6 SIS and 6 CHS. Core temperature (coreT degrees) was measured with a flexible probe in the lower lobe bronchus after unpacking and every 10 minutes during implantation. RESULTS: Regarding SIS, mean +/- standard deviation (SD) surfaceT degrees was 30 degrees C +/- 3.3 degrees C before flushing, 17 degrees C +/- 4.1 degrees C after extraction, 8.6 degrees C +/- 3.3 degrees C before packing. PreservationT degrees reached 4 degrees C after 98 minutes and 0 degrees C after 266 minutes. After unpacking, surfaceT degrees was 1.8 degrees C +/- 2.3 degrees C, coreT degrees was 1.6 degrees C +/- 1.2 degrees C. At 30 minutes implantation, surfaceT degrees was 25.0 degrees C +/- 2.9 degrees C, coreT degrees was 22.0 degrees C +/- 4.4 degrees C. CHS surfaceT degrees was 30.0 degrees C +/- 2.5 degrees C before flushing, 17 degrees C +/- 3.8 degrees C after extraction, and 11 degrees C +/- 3.5 degrees C before packing. After unpacking, surfaceT degrees was 7.9 degrees C +/- 2.0 degrees C, and coreT degrees was 7.1 degrees C +/- 1.1 degrees C. At 30 minutes of implantation, surfaceT degrees was 26.0 degrees C +/- 1.7 degrees C, and coreT degrees was 24.0 degrees C +/- 3.6 degrees C. Postoperative outcome was comparable between both groups. CONCLUSIONS: We characterized temperature dynamics in clinical LTx, revealing a rapid temperature drop with pulmonary flushing, potential freezing injury with SIS, and rapid rewarming during implantation. J Heart Lung Transplant 2025;44:1737-1746 (c) 2025 International Society for Heart and Lung Transplantation. All rights are reserved, including those for text and data mining, AI training, and similar technologies.