Static lung preservation at 10 °C: a narrative review of the evidence base and implementation opportunities for lung transplantation in resource-constrained settings, with a focus on Latin America.

BACKGROUND: Cold static lung preservation on ice at approximately 4 °C, with a 6-8 h ischemic ceiling, has constrained donor use, geographic reach, and operating-room logistics for three decades. Preclinical and clinical evidence now supports static storage at approximately 10 °C (controlled hypothermic storage) as an alternative with a plausible mechanistic advantage that extends the safe preservation window.

OBJECTIVES: To map the evidence for static 10 °C lung preservation and translate it into implementation opportunities for resource-constrained programs, using Latin America as a case study.

METHODS: This is a narrative review, not a systematic or scoping review. The authors searched PubMed/MEDLINE, Cochrane CENTRAL, SciELO, and LILACS (1990-2026) and the ClinicalTrials.gov register, complemented by hand-searching of reference lists and registries; the search was iterative and citation-driven rather than a single reproducible protocol, and no PRISMA-type flow diagram is presented. Studies addressing static lung preservation at temperatures ≥5 °C, or its operational and economic implications in resource-constrained settings, were selected at the authors' judgment.

RESULTS: Sixteen studies are summarized. Two preclinical studies established the mechanistic basis; a multicenter cohort from Toronto, Vienna, and Madrid, single-center cohorts from Spain, Italy, and the United States, and a pooled analysis of preservation up to 24 h consistently found early outcomes comparable to ice despite total preservation times of 12-18 h; and an international randomized trial (NCT05898776) has completed interim safety analysis with the primary-endpoint report pending. No study has shown harm from 10 °C, but none was designed to show superiority, and differences in primary graft dysfunction have not reached significance; isolated cohorts report numerically more postoperative extracorporeal support or longer ventilation with the most prolonged preservation, and long-term and donation-after-circulatory-death data are scarce. Detailed registry data on controlled hypothermic storage at 4-8 °C, a distinct technique, are outside this review's scope.

CONCLUSIONS: Static 10 °C preservation is a low-cost innovation that reframes lung transplantation from an emergency to a semi-elective procedure. In resource-constrained settings, it could enable nation-scale procurement, sequential single-lung use of scarce donors, single-team heart-then-lung sequencing, daytime implantation, cross-border donor-recipient pairing, and commercial-aviation transport; integration with ex vivo lung perfusion may compound these gains. Publication of the definitive randomized trial and dedicated economic analyses remain.