10°C vs 4°C Lung Preservation RCT

NCT ID: NCT05898776

Last Updated: 2025-06-12

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

300 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-06-09

Study Completion Date

2026-07-01

Brief Summary

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Despite lung transplantation (LTx) being the most effective treatment for end-stage lung disease, its success rate is lower than that of other solid organ transplantations. Primary graft dysfunction (PGD) is the most common post-operative complication and a major factor in early mortality and morbidity, affecting \~25% of lung transplant patients. Induced by ischemia reperfusion, PGD represents a severe and acute lung injury that occurs within the first 72 hours after transplantation, and has a significant impact on short- and long-term outcomes, and a significant increase in treatment costs. Any intervention that reduces the risk of PGD will lead to major improvements in short- and long-term transplant outcomes and health care systems.

One of the main strategies to reduce the risk and severity of post-transplant PGD is to improve pre-transplant donor lung preservation methods. In current practice, lung preservation is typically performed by cold flushing the organ with a specialized preservation solution, followed by subsequent hypothermic storage on ice (\~4°C). This method continues to be used and applied across different organ systems due to its simplicity and low cost. Using this method for the preservation of donor lungs, the current maximum accepted preservation times have been limited to approximately 6-8h. While the goal of hypothermic storage is to sustain cellular viability during ischemic time through reduced cellular metabolism, lower organ temperature has also been shown to progressively favor mitochondrial dysfunction. Therefore, the ideal temperature for donor organ preservation remains to be defined and should maintain a balance between avoidance of mitochondrial dysfunction and prevention of cellular exhaustion. In addition to that, safe and longer preservation times can lead to multiple advantages such as moving overnight transplants to daytime, more flexibility to transplant logistics, more time for proper donor to recipient matching etc.

Building on pre-clinical research suggesting that 10°C may be the optimal lung storage temperature, a prospective, multi-center, non-randomized clinical trial was conducted at University Health Network, Medical University of Vienna and Puerta de Hierro Majadahonda University Hospital. Donor lungs meeting criteria for direct transplantation and with cross clamp times between 6:00pm - 4:00am were intentionally delayed to an earliest allowed start time of 6:00am and a maximum preservation time from donor cold flush to recipient anesthesia start time of 12 hours. Lungs were retrieved and transported in the usual fashion using a cooler with ice and transferred to a 10°C temperature-controlled cooler upon arrival to transplant hospital until implantation. The primary outcome of this study was incidence of Primary Graft Dysfunction (PGD) Grade 3 at 72h, with secondary endpoints including: recipient time on the ventilator, ICU Length of Stay (LOS), hospital LOS, 30-day survival and lung function at 1-year. Outcomes were compared to a contemporaneous conventionally transplanted recipient cohort using propensity score matching at a 1:2 ratio. 70 patients were included in the study arm. Post-transplant outcomes were comparable between the two groups for up to 1 year. Thus, intentional prolongation of donor lung preservation at 10°C was shown to be clinically safe and feasible.

In the current study design, the investigators will conduct a multi-centre, non-inferiority, randomized, controlled trial of 300 participants to compare donor lung preservation from the time of explant to implant at \~10°C in X°Port Lung Transport Device (Traferox Technologies Inc.) vs a standard ice cooler. When eligible donor lungs become available for a consented recipient, the lungs will be randomized to undergo a preservation protocol using either 10°C (X°Port Lung Transport Device, Traferox Technologies Inc.) or standard of care. The primary outcome of the study is incidence of ISHLT Primary Graft Dysfunction Grade 3 at 72 hours. Post-transplant outcomes will be followed for one year.

Detailed Description

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Conditions

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Lung Transplant Organ Preservation

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Outcome Assessors

Study Groups

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10°C lung preservation

Group Type EXPERIMENTAL

Lung transplantation after 10°C donor lung preservation

Intervention Type DEVICE

When suitable donor lungs become available for a, eligible, consented recipient and meet criteria to go straight to transplantation, the lungs randomized to 10°C preservation will be stored, transported and preserved in the X°Port Lung Transport Device (Traferox Technologies Inc.) until implant with a maximum time of 12 hours between the donor and recipient surgeries.

Standard lung preservation

Group Type ACTIVE_COMPARATOR

Lung transplantation after standard ice cooler donor lung preservation

Intervention Type DEVICE

When suitable donor lungs become available for a, eligible, consented recipient and meet criteria to go straight to transplantation, the lungs randomized to standard preservation will be will be stored, transported and preserved in an ice cooler (\~4°C, standard of care) until implant with a maximum time of 6 hours between the donor and recipient surgeries.

Interventions

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Lung transplantation after 10°C donor lung preservation

When suitable donor lungs become available for a, eligible, consented recipient and meet criteria to go straight to transplantation, the lungs randomized to 10°C preservation will be stored, transported and preserved in the X°Port Lung Transport Device (Traferox Technologies Inc.) until implant with a maximum time of 12 hours between the donor and recipient surgeries.

Intervention Type DEVICE

Lung transplantation after standard ice cooler donor lung preservation

When suitable donor lungs become available for a, eligible, consented recipient and meet criteria to go straight to transplantation, the lungs randomized to standard preservation will be will be stored, transported and preserved in an ice cooler (\~4°C, standard of care) until implant with a maximum time of 6 hours between the donor and recipient surgeries.

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

* Donation after brain death (DBD) or donation after cardiac death (DCD)
* Donor lungs are suitable to go straight to LTx (i.e., do not need ex vivo lung perfusion (EVLP) assessment)


* 18-80 years old
* Primary lung transplantation
* Bilateral lung transplantation

Exclusion Criteria

* Concerns with organ preservation technique
* Need for EVLP assessment


* Re-transplantation
* Multi-organ transplantation
* Single lung transplantation
* Participation in a contraindicating trial
Minimum Eligible Age

18 Years

Maximum Eligible Age

80 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Medical University of Vienna

OTHER

Sponsor Role collaborator

Vanderbilt University

OTHER

Sponsor Role collaborator

Puerta de Hierro University Hospital

OTHER

Sponsor Role collaborator

University of California, San Francisco

OTHER

Sponsor Role collaborator

Centre Hospitalier Universitaire Vaudois

OTHER

Sponsor Role collaborator

Mayo Clinic

OTHER

Sponsor Role collaborator

St Vincent's Hospital, Sydney

OTHER

Sponsor Role collaborator

University of Texas Southwestern Medical Center

OTHER

Sponsor Role collaborator

Spectrum Health Hospitals

OTHER

Sponsor Role collaborator

University of Miami

OTHER

Sponsor Role collaborator

University Hospital of Leuven Leuven

OTHER

Sponsor Role collaborator

Centre hospitalier de l'Université de Montréal (CHUM)

OTHER

Sponsor Role collaborator

University Hospital, Zürich

OTHER

Sponsor Role collaborator

University Health Network, Toronto

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Elliot Wakeam, MD MPH

Role: PRINCIPAL_INVESTIGATOR

University Health Network, Toronto

Locations

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University of California San Francisco

San Francisco, California, United States

Site Status RECRUITING

University of Miami

Coral Gables, Florida, United States

Site Status RECRUITING

Corewell Health Research Institute

Grand Rapids, Michigan, United States

Site Status RECRUITING

Mayo Clinic

Rochester, Minnesota, United States

Site Status RECRUITING

Vanderbilt University Medical Center

Nashville, Tennessee, United States

Site Status RECRUITING

University of Texas Southwestern Medical Center

Dallas, Texas, United States

Site Status RECRUITING

St Vincent's Hospital Sydney Limited

Sydney, New South Wales, Australia

Site Status RECRUITING

Medical University of Vienna

Vienna, , Austria

Site Status RECRUITING

University Hospitals Leuven

Leuven, , Belgium

Site Status RECRUITING

University Health Network (Toronto General Hospital)

Toronto, Ontario, Canada

Site Status RECRUITING

Centre hospitalier de l'Université de Montréal

Montreal, Quebec, Canada

Site Status RECRUITING

Hospital Universitario Puerta de Hierro-Majadahonda

Madrid, , Spain

Site Status RECRUITING

Centre Hospitalier Universitaire Vaudois (CHUV)

Lausanne, , Switzerland

Site Status RECRUITING

University Hospital Zurich

Zurich, , Switzerland

Site Status RECRUITING

Countries

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United States Australia Austria Belgium Canada Spain Switzerland

Central Contacts

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Sharaniyaa Balachandran

Role: CONTACT

416-340-4800 ext. 6549

Facility Contacts

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Jasleen Kukreja, MD MPH

Role: primary

Mauricio Pipkin, MD

Role: primary

Edward Murphy, MD

Role: primary

Sahar A Saddoughi, MD PhD

Role: primary

Anil J Trindade, MD

Role: primary

John Murala, MD

Role: primary

David Darley, MBBS

Role: primary

Konrad Hoetzenecker, MD PhD

Role: primary

Laurens Ceulemans, MD, PhD

Role: primary

Sharaniyaa Balachandran

Role: primary

416-340-4800 ext. 6549

Basil Nasir, MBBCh

Role: primary

Jose L Campo-Cañaveral de la Cruz, MD PhD

Role: primary

Thorsten Krueger, MD

Role: primary

Isabelle Schmitt-Opitz, MD

Role: primary

Other Identifiers

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22-5909

Identifier Type: -

Identifier Source: org_study_id

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