Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Sep 18, 2025; 15(3): 102150
Published online Sep 18, 2025. doi: 10.5500/wjt.v15.i3.102150
Extended travel for donor organs: Is cold static storage still relevant
Montana Reynolds, Martin Gerard Walsh, Ervin Y Cui, Divyaam Satija, Doug A Gouchoe, Matthew C Henn, Kukbin Choi, Nahush A Mokadam, Asvin M Ganapathi, Bryan A Whitson
Montana Reynolds, Martin Gerard Walsh, Ervin Y Cui, Doug A Gouchoe, COPPER Laboratory, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43201, United States
Martin Gerard Walsh, Divyaam Satija, Doug A Gouchoe, Matthew C Henn, Kukbin Choi, Nahush A Mokadam, Asvin M Ganapathi, Bryan A Whitson, Division of Cardiac Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43201, United States
Co-first authors: Montana Reynolds and Martin Gerard Walsh.
Author contributions: Reynolds M, Walsh MG, Cui EY, Satija D, Gouchoe DA, and Whitson BA wrote original manuscript; Cui EY, Satija D, Gouchoe DA, Henn MC, and Ganapathi AM performed formal analysis; Henn MC, Choi K, Mokadam NA, Ganapathi AM, and Whitson BA contributed to design, methodology, validation, visualization, and made critical revisions to the manuscript; all authors had final approval of this manuscript.
Supported by The Jewel and Frank Benson Family Endowment; and The Jewel and Frank Benson Research Professorship.
Institutional review board statement: The study was deemed exempt from institutional review board (No. 2018H0079; approved 2/20/2018; last renewed 2/9/2024).
Informed consent statement: Informed consent was not necessary given the retrospective nature of this study.
Conflict-of-interest statement: Mokadam NA is a consultant and investigator for Abbott, Medtronic, Carmat, Xylocor and SynCardia; Ganapathi AM is a prior consultant for Traferox; Whitson BA serves on the Clinical Events Committee of TransMedics OCS.
Data sharing statement: Statistical coding and dataset available from the corresponding author at bryan.whitson@osumc.edu. Consent was not obtained but the presented data are anonymized, and risk of identification is low. No additional data are available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Bryan A Whitson, MD, PhD, Professor, Division of Cardiac Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, N-816 Doan Hall, 410 W 10th Avenue, Columbus, OH 43201, United States. bryan.whitson@osumc.edu
Received: October 9, 2024
Revised: March 16, 2025
Accepted: April 1, 2025
Published online: September 18, 2025
Processing time: 190 Days and 11.5 Hours
Abstract
BACKGROUND

Traditional limitations of cold static storage (CSS) on ice at 4 °C during lung transplantation have necessitated limiting cold ischemic time (CIT) to 4-6 hours. Ex vivo lung perfusion (EVLP) can extend this preservation time through the suspension of CIT and normothermic perfusion. As we continue to further expand the donor pool in all aspects of lung transplantation, teams are frequently traveling further distances to procure organs.

AIM

To determine the effect of CSS or EVLP on donors with extended travel distance [> 750 nautical miles (NM)] to recipient.

METHODS

Lung transplants, whose donor traveled greater than 750 NM, were identified from the United Network for Organ Sharing Database. Recipients were stratified into either: CSS or EVLP, based on preservation method. Groups were assessed with comparative statistics and survival was assessed by Kaplan-Meier methods. A 3:1 propensity match was then created, and same analysis was repeated.

RESULTS

Prior to matching, those in the EVLP group had significantly increased post-operative morbidity to include dialysis, ventilator use, acute rejection, and treated rejection in the first year (P < 0.05 for all). However, there were no significant differences in midterm survival (P = 0.18). Following matching, those in the EVLP group again had significantly increased post-operative morbidity to include dialysis, extracorporeal membrane oxygenation use, ventilator use, and treated rejection in the first year (P < 0.05 for all). As before, there were no significant differences in midterm survival following matching (P = 0.08).

CONCLUSION

While there was no significant difference in survival, EVLP patients had increased peri-operative morbidity. With the advent of changes in CSS with 10 °C storage further analysis is necessary to evaluate the best methods for utilizing organs from increased distances.

Keywords: Transplantation lung; Ex vivo lung perfusion; Ischemic time; Machine perfusion; United Network for Organ Sharing; Cold static storage; Normothermic perfusion

Core Tip: This study investigates the effectiveness of cold static storage (CSS) vs ex vivo lung perfusion (EVLP) for donor lungs transported over 750 nautical miles. Midterm survival outcomes were similar but recipients in the EVLP group experienced significantly higher perioperative morbidity, including post-operative dialysis and ventilator use. If ischemic times remain less than 8 hours, CSS remains likely a viable option for extended travel, especially in resource-limited settings. This research provides important insights for transplant centers seeking to optimize organ preservation strategies for long-distance donor retrieval.