Objective: To describe our experience with lung transplantation (LTx) from donors ≥70 years and compare short and long-term outcomes to a propensity-matched cohort of donors <70 years. Background: Although extended-criteria donors have been widely used to enlarge the donor pool, the experience with LTx from older donors (≥70 years) remains limited. Methods: All single-center bilateral LTx between 2010 and 2020 were retrospectively analyzed. Matching (1:1) was performed for the donor (type, sex, smoking history, x-ray abnormalities, partial pressure of oxygen/fraction of inspired oxygen ratio, and time on ventilator) and recipient characteristics (age, sex, LTx indication, perioperative extracorporeal life support, and cytomegalovirus mismatch). Primary graft dysfunction grade-3, 5-year patient, and chronic lung allograft dysfunction-free survival were analyzed. Results: Out of 647 bilateral LTx, 69 were performed from donors ≥70 years. The mean age in the older donor cohort was 74 years (range: 70–84 years) versus 49 years (range: 12–69 years) in the matched younger group. No significant differences were observed in the length of ventilatory support, intensive care unit, or hospital stay. Primary graft dysfunction-3 was 26% in the older group versus 29% in younger donor recipients (P = 0.85). Reintervention rate was comparable (29% vs 16%; P = 0.10). Follow-up bronchoscopy revealed no difference in bronchial anastomotic complications (P = 1.00). Five-year patient and chronic lung allograft dysfunction-free survivals were 73.6% versus 73.1% (P = 0.72) and 51.5% versus 59.2% (P = 0.41), respectively. Conclusions: LTx from selected donors ≥70 years is feasible and safe, yielding comparable short and long-term outcomes in a propensity-matched analysis with younger donors (<70 years).

Background: Static ice storage (SIS) has long been accepted as the conventional lung preservation method, assuming to maintain 4 °C temperature. Although never directly confirmed by temperature measurements, this assumption has been widely accepted. We aimed to measure lung and preservation temperature with SIS in porcine experiments and clinical observations. Methods: Porcine lungs were preserved with SIS for 8 h (group I, n = 3) and 3 h followed by 10 °C storage (group II, n = 3). Tissue (tissueT°), first bag preservation solution (psT°) and second bag saline (salineT°) temperature were monitored. In clinical lungs (n = 4), psT° was monitored during SIS. Surface (surfaceT°) and core (coreT°) temperature were assessed before and after SIS (n = 62). Results: After 4 h in porcine lung group I, average tissueT° was 0.66 °C, psT° was 0.12 °C and salineT° was −0.02 °C. After 3 h in group II, average tissueT° was 1.90 °C, psT° was 0.57 °C and salineT° was 2.33 °C. In clinical observations, psT° was below 4 °C after 9–13 min and 0 °C after 78–267 min. After SIS, median surfaceT° was 1.25 °C (min-max; −3.2–9.2 °C) and coreT° was 1.45 °C (−0.4–4.8 °C). Conclusions: SIS leads to rapid temperature drops below 4 °C, approaching 0 °C within 2–4 h. The post-SIS lung temperature shows considerable variability and does not consistently remain at the commonly assumed 4 °C, posing potential freezing injury to donor lungs.

Extended pleurectomy–decortication is a cytoreductive surgical treatment for malignant pleural mesothelioma. Prolonged air leak remains a major postoperative challenge, lengthening hospital stay and increasing morbidity. In this video report, we present a stepwise approach for visceral decortication and introduce the concept of aerostasis by construction of an artificial neopleura. Our results suggest that improved aerostasis results in shortened air leak duration.