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©The Author(s) 2025.
World J Transplant. Sep 18, 2025; 15(3): 102150
Published online Sep 18, 2025. doi: 10.5500/wjt.v15.i3.102150
Published online Sep 18, 2025. doi: 10.5500/wjt.v15.i3.102150
Table 1 Recipient characteristics, n (%)
Variable | Overall (n = 897) | Cold static storage (n = 792) | Ex vivo lung perfusion (n = 105) | P value |
Age | 64 (57, 68) | 64 (57, 68) | 63 (56, 68) | 0.365 |
Male sex | 551 (61.4) | 490 (61.9) | 61 (58.1) | 0.522 |
Race | 0.816 | |||
White | 659 (73.5) | 582 (73.5) | 77 (73.3) | |
Black | 89 (9.9) | 77 (9.7) | 12 (11.4) | |
Other | 149 (16.6) | 133 (16.8) | 16 (15.2) | |
Body mass index (kg/m2) | 26.6 (23.3, 29.4) | 26.7 (23.3, 29.4) | 26.4 (23.7, 29.3) | 0.67 |
Diabetes | 150 (16.8) | 128 (16.3) | 22 (21) | 0.286 |
Former smoker | 509 (56.7) | 444 (56.1) | 65 (61.9) | 0.404 |
Glomerular filtration rate (mL/minute/1.73 m2) | 91 (74.6, 119.3) | 90.3 (74.4, 117.8) | 97.2 (76.7, 125.3) | 0.286 |
Mean pulmonary artery pressure (mm Hg) | 25 (20, 30.5) | 25 (20, 30) | 24 (21, 32) | 0.477 |
Diagnosis | 0.755 | |||
Cystic fibrosis/immunodeficiency | 24 (2.7) | 21 (2.7) | 3 (2.9) | |
Obstructive lung disease | 207 (23.1) | 179 (22.6) | 28 (26.7) | |
Pulmonary vascular disease | 36 (4) | 31 (3.9) | 5 (4.8) | |
Restrictive lung disease | 630 (70.2) | 561 (70.8) | 69 (65.7) | |
Lung allocation score | 41.2 (35.7, 55.2) | 41.3 (35.8, 55.9) | 40.5 (35.5, 53.7) | 0.434 |
Hospitalized prior to transplant | 0.8 | |||
Not hospitalized | 643 (75.5) | 561 (75.1) | 82 (78.1) | |
Hospitalized | 82 (9.6) | 73 (9.8) | 9 (8.6) | |
In intensive care unit | 127 (14.9) | 113 (15.1) | 14 (13.3) | |
Pre-operative ventilator | 47 (5.2) | 44 (5.6) | 3 (2.9) | 0.351 |
Pre-operative extracorporeal membrane oxygenation | 58 (6.5) | 54 (6.8) | 4 (3.8) | 0.334 |
Days on wait list | 34 (12, 117) | 33 (12, 116) | 42 (14, 122) | 0.482 |
Table 2 Donor characteristics, n (%)
Variable | Overall (n = 897) | Cold static storage (n = 792) | Ex vivo lung perfusion (n = 105) | P value |
Age | 35 (25, 48) | 35 (24, 47) | 38 (25, 51) | 0.082 |
Male sex | 562 (62.7) | 497 (62.8) | 65 (61.9) | 0.951 |
Coronary artery disease | 57 (6.5) | 52 (6.8) | 5 (4.8) | 0.585 |
Smoking history | 86 (9.8) | 74 (9.6) | 12 (11.5) | 0.648 |
Recent cocaine use | 195 (22.1) | 172 (22.1) | 23 (22.1) | 0.5 |
Diabetes | 95 (10.7) | 84 (10.7) | 11 (10.6) | 0.999 |
Hypertension | 240 (26.9) | 211 (26.8) | 29 (27.6) | 0.954 |
Alcohol abuse | 180 (20.7) | 162 (21.2) | 18 (17.3) | 0.429 |
Body mass index (kg/m2) | 26 (23, 30) | 25.9 (23, 29.9) | 27.1 (23, 32.7) | 0.15 |
PaO2/FiO2 ratio | 449 (396.9, 506) | 454 (400, 507.4) | 408.5 (361, 487.1) | < 0.001 |
Donor cause of death | 0.568 | |||
Neuro (seizure/cerebral vascular accident) | 259 (28.9) | 231 (29.2) | 28 (26.9) | |
Drug overdose | 136 (15.2) | 126 (15.9) | 10 (9.6) | |
Asphyxiation | 56 (6.2) | 48 (6.1) | 8 (7.7) | |
Cardiovascular | 71 (7.9) | 61 (7.7) | 10 (9.6) | |
Trauma (gun shot wound/stab/blunt) | 331 (36.9) | 290 (36.6) | 41 (39.4) | |
Drowning | 4 (0.4) | 3 (0.4) | 1 (1) | |
Other | 39 (4.4) | 33 (4.2) | 6 (5.8) | |
Donation after circulatory death | 94 (10.5) | 62 (7.8) | 32 (30.5) | < 0.001 |
Table 3 Transplant outcomes, n (%)
Variable | Overall (n = 897) | Cold static storage (n = 792) | Ex vivo lung perfusion (n = 105) | P value |
Center volume | 30 (12, 56) | 30 (12, 56) | 32 (14, 56) | 0.526 |
Center volume yearly | 2 (0.8, 3.7) | 2 (0.8, 3.7) | 2.1 (0.9, 3.7) | 0.526 |
Perfused by | ||||
Organ perfusion organization | 2 (1.9) | |||
Transplant program | 61 (58.7) | |||
External perfusion center | 41 (39.4) | |||
Perfusion time | 296 (218, 496) | |||
Warm ischemic time | 24 (19.3, 28) | 24 (19, 26.8) | 25.5 (20, 30.3) | 0.113 |
Type of lung transplant | 0.001 | |||
Bilateral | 653 (72.8) | 561 (70.8) | 92 (87.6) | |
Right single | 100 (11.1) | 96 (12.1) | 4 (3.8) | |
Left single | 144 (16.1) | 135 (17) | 9 (8.6) | |
Distance traveled (nautical miles) | 898 (824, 1006) | 900 (824, 1006) | 892 (826, 1058) | 0.96 |
Ischemic time (hours) | 7.3 (6.2, 8.8) | 7.1 (6.1, 8.2) | 13.5 (10.8, 16.2) | < 0.001 |
Length of stay (days) | 20 (13, 38) | 20 (13, 37) | 22 (14, 48.5) | 0.553 |
In-hospital mortality | 59 (7.2) | 50 (7) | 9 (8.7) | 0.668 |
Postop dialysis | 81 (9.6) | 65 (8.8) | 16 (15.4) | 0.049 |
Postop stroke | 34 (4) | 30 (4) | 4 (3.8) | 0.999 |
Airway dehiscence | 16 (1.9) | 16 (2.2) | 0 (0) | 0.254 |
Post-operative extracorporeal membrane oxygenation | 97 (11.5) | 79 (10.7) | 18 (17.3) | 0.068 |
Post-operative ventilator | 0.011 | |||
None | 7 (0.8) | 5 (0.7) | 2 (1.9) | |
< 2 days | 445 (53.1) | 405 (55.1) | 40 (38.8) | |
2-5 days | 167 (19.9) | 143 (19.5) | 24 (23.3) | |
5+ days | 219 (26.1) | 182 (24.8) | 37 (35.9) | |
Primary graft dysfunction grade 3 | 123 (13.7) | 108 (13.6) | 15 (14.3) | 0.975 |
Acute rejection (hospitalization) | 0.014 | |||
Yes and treated with immunosuppressant | 49 (5.8) | 38 (5.1) | 11 (10.5) | |
Yes and not treated with Immunosuppressant | 5 (0.6) | 3 (0.4) | 2 (1.9) | |
No | 792 (93.6) | 700 (94.5) | 92 (87.6) | |
Treated rejection (1st year) | 84 (16.2) | 63 (13.9) | 21 (30.9) | 0.001 |
Cause of death | 0.827 | |||
Graft failure | 35 (17.9) | 32 (18.3) | 3 (15) | |
Malignancy | 4 (2.1) | 4 (2.3) | 0 (0) | |
Cardio/cerebrovascular | 29 (14.9) | 25 (14.3) | 4 (20) | |
Pulmonary | 33 (16.9) | 29 (16.6) | 4 (20) | |
Infection | 58 (29.7) | 51 (29.1) | 7 (35) | |
Other | 36 (18.5) | 34 (19.4) | 2 (10) | |
Year of transplant | ||||
2018 | 96 (10.7) | 83 (10.5) | 13 (12.4) | |
2019 | 142 (15.8) | 122 (15.4) | 20 (19) | |
2020 | 170 (19) | 153 (19.3) | 17 (16.2) | |
2021 | 209 (23.3) | 180 (22.7) | 29 (27.6) | |
2022 | 220 (24.5) | 197 (24.9) | 23 (21.9) | |
2023 | 60 (6.7) | 57 (7.2) | 3 (2.9) |
Table 4 Matched recipient characteristics, n (%)
Variable | Overall (n = 416) | Cold static storage (n = 312) | Ex vivo lung perfusion (n = 104) | P value |
Age | 62 (55.8, 67) | 62 (55.8, 67) | 63 (55.5, 68) | 0.621 |
Male sex | 244 (58.7) | 183 (58.7) | 61 (58.7) | 0.999 |
Race | 0.92 | |||
White | 305 (73.3) | 229 (73.4) | 76 (73.1) | |
Black | 44 (10.6) | 32 (10.3) | 12 (11.5) | |
Other | 67 (16.1) | 51 (16.3) | 16 (15.4) | |
Body mass index (kg/m2) | 26.4 (23, 29.2) | 26.4 (23, 29.2) | 26.4 (23.6, 29.3) | 0.75 |
Diabetes | 95 (22.8) | 73 (23.4) | 22 (21.2) | 0.736 |
Former smoker | 236 (56.7) | 171 (54.8) | 65 (62.5) | 0.209 |
Glomerular filtration rate (mL/minute/1.73 m2) | 93.8 (76, 121.1) | 93.2 (76, 118) | 97.6 (76.5, 125.5) | 0.54 |
Mean pulmonary artery pressure (mm Hg) | 24 (20, 31) | 24 (19, 31) | 24 (21, 31.5) | 0.457 |
Diagnosis | 0.999 | |||
Cystic fibrosis/immunodeficiency | 12 (2.9) | 9 (2.9) | 3 (2.9) | |
Obstructive lung disease | 114 (27.4) | 86 (27.6) | 28 (26.9) | |
Pulmonary vascular disease | 20 (4.8) | 15 (4.8) | 5 (4.8) | |
Restrictive lung disease | 270 (64.9) | 202 (64.7) | 68 (65.4) | |
Lung allocation score | 40.5 (34.9, 52.7) | 40.4 (34.6, 52.8) | 40.5 (35.4, 52.2) | 0.987 |
Hospitalized prior to transplant | 0.992 | |||
Not hospitalized | 324 (77.9) | 243 (77.9) | 81 (77.9) | |
Hospitalized | 35 (8.4) | 26 (8.3) | 9 (8.7) | |
In intensive care unit | 57 (13.7) | 43 (13.8) | 14 (13.5) | |
Pre-operative ventilator | 18 (4.3) | 15 (4.8) | 3 (2.9) | 0.578 |
Pre-operative extracorporeal membrane oxygenation | 24 (5.8) | 20 (6.4) | 4 (3.8) | 0.466 |
Days on wait list | 38 (12, 123) | 34.5 (12, 121.8) | 41.5 (13.8, 123) | 0.765 |
Table 5 Matched donor characteristics, n (%)
Variable | Overall (n = 416) | Cold static storage (n = 312) | Ex vivo lung perfusion (n = 104) | P value |
Age | 38 (27, 51) | 38.5 (28, 51) | 38 (25, 51.2) | 0.708 |
Male sex | 250 (60.1) | 186 (59.6) | 64 (61.5) | 0.817 |
Coronary artery disease | 27 (6.5) | 22 (7.1) | 5 (4.9) | 0.58 |
Smoking history | 41 (10) | 29 (9.5) | 12 (11.5) | 0.677 |
Recent cocaine use | 98 (23.6) | 75 (24.1) | 23 (22.1) | 0.209 |
Diabetes | 41 (9.9) | 30 (9.6) | 11 (10.6) | 0.924 |
Hypertension | 116 (27.9) | 88 (28.2) | 28 (26.9) | 0.9 |
Alcohol abuse | 95 (23.1) | 77 (25.1) | 18 (17.3) | 0.136 |
Body mass index (kg/m2) | 27.2 (23.7, 30.8) | 27.3 (24.1, 30.7) | 27 (22.9, 32.1) | 0.544 |
PaO2/FiO2 ratio | 446 (394, 503.1) | 453.5 (400, 504.2) | 409 (360, 488.2) | 0.001 |
Donor cause of death | 0.252 | |||
Neuro (seizure/cerebral vascular accident) | 118 (28.4) | 91 (29.2) | 27 (26.2) | |
Drug overdose | 58 (14) | 48 (15.4) | 10 (9.7) | |
Asphyxiation | 20 (4.8) | 12 (3.8) | 8 (7.8) | |
Cardiovascular | 41 (9.9) | 31 (9.9) | 10 (9.7) | |
Trauma (gun shot wound/stab/blunt) | 154 (37.1) | 113 (36.2) | 41 (39.8) | |
Drowning | 1 (0.2) | 0 (0) | 1 (1) | |
Other | 23 (5.5) | 17 (5.4) | 6 (5.8) | |
Donation after circulatory death | 56 (13.5) | 25 (8) | 31 (29.8) | < 0.001 |
Table 6 Matched transplant outcomes, n (%)
Variable | Overall (n = 416) | Cold static storage (n = 312) | Ex vivo lung perfusion (n = 104) | P value |
Center volume | 32 (14, 56) | 32 (14, 56) | 32 (14, 56) | 0.761 |
Center volume yearly | 2.1 (0.9, 3.7) | 2.1 (0.9, 3.7) | 2.1 (0.9, 3.7) | 0.761 |
Perfused by | ||||
Organ perfusion organization | 0 (N/A) | 2 (1.9) | ||
Transplant program | 0 (N/A) | 61 (59.2) | ||
External perfusion center | 0 (N/A) | 40 (38.8) | ||
Perfusion time | 294.5 (217, 507) | |||
Warm ischemic time | 24 (19.7, 28.5) | 23 (18, 26) | 25 (20, 30) | 0.129 |
Type of lung transplant | 0.009 | |||
Bilateral | 319 (76.7) | 228 (73.1) | 91 (87.5) | |
Right single | 40 (9.6) | 36 (11.5) | 4 (3.8) | |
Left single | 57 (13.7) | 48 (15.4) | 9 (8.7) | |
Distance traveled (nautical miles) | 894 (826, 1006.2) | 900 (825.5, 1000.8) | 892 (826.8, 1062.8) | 0.862 |
Ischemic time (hours) | 7.7 (6.4, 10.3) | 7.1 (6.1, 8.2) | 13.6 (10.8, 16.2) | < 0.001 |
Length of stay (days) | 19 (13, 37) | 19 (13, 35.8) | 22 (14, 48.5) | 0.278 |
In-hospital mortality | 31 (7.7) | 22 (7.3) | 9 (8.7) | 0.798 |
Postop dialysis | 38 (9.2) | 23 (7.4) | 15 (14.6) | 0.046 |
Postop stroke | 18 (4.3) | 14 (4.5) | 4 (3.8) | 0.99 |
Airway dehiscence | 10 (2.4) | 10 (3.2) | 0 (0) | 0.139 |
Post-operative extracorporeal membrane oxygenation | 43 (10.4) | 26 (8.3) | 17 (16.5) | 0.03 |
Post-operative ventilator | 0.02 | |||
None | 6 (1.5) | 4 (1.3) | 2 (2) | |
< 2 days | 213 (51.8) | 173 (56) | 40 (39.2) | |
2-5 days | 87 (21.2) | 63 (20.4) | 24 (23.5) | |
5+ days | 105 (25.5) | 69 (22.3) | 36 (35.3) | |
Primary graft dysfunction grade 3 | 59 (14.2) | 45 (14.4) | 14 (13.5) | 0.935 |
Acute rejection (hospitalization) | 0.052 | |||
Yes and treated with immunosuppressant | 26 (6.2) | 15 (4.8) | 11 (10.6) | |
Yes and not treated with Immunosuppressant | 4 (1) | 2 (0.6) | 2 (1.9) | |
No | 386 (92.8) | 295 (94.6) | 91 (87.5) | |
Treated rejection (1st year) | 44 (17.7) | 23 (12.7) | 21 (30.9) | 0.002 |
Cause of death | 0.625 | |||
Graft failure | 17 (18.1) | 14 (18.7) | 3 (15.8) | |
Malignancy | 1 (1.1) | 1 (1.3) | 0 (0) | |
Cardio/cerebrovascular | 13 (13.8) | 9 (12) | 4 (21.1) | |
Pulmonary | 16 (17) | 12 (16) | 4 (21.1) | |
Infection | 31 (33) | 24 (32) | 7 (36.8) | |
Other | 16 (17) | 15 (20) | 1 (5.3) | |
Year of transplant | ||||
2018 | 44 (10.6) | 31 (9.9) | 13 (12.5) | |
2019 | 69 (16.6) | 49 (15.7) | 20 (19.2) | |
2020 | 88 (21.2) | 71 (22.8) | 17 (16.3) | |
2021 | 99 (23.8) | 70 (22.4) | 29 (27.9) | |
2022 | 109 (26.2) | 87 (27.9) | 22 (21.2) | |
2023 | 7 (1.7) | 4 (1.3) | 3 (2.9) |
- Citation: Reynolds M, Walsh MG, Cui EY, Satija D, Gouchoe DA, Henn MC, Choi K, Mokadam NA, Ganapathi AM, Whitson BA. Extended travel for donor organs: Is cold static storage still relevant. World J Transplant 2025; 15(3): 102150
- URL: https://www.wjgnet.com/2220-3230/full/v15/i3/102150.htm
- DOI: https://dx.doi.org/10.5500/wjt.v15.i3.102150