New Lung Preservation Studies Reveal Insights of Optimizing Temperature, Airway Pressure Control

New clinical research reinforces the importance of precise controlled hypothermic preservation and active airway pressure management in lung transplantation.

Rooted in research conducted through the GUARDIAN-Lung Registry (a post-market observational study sponsored by Paragonix Technologies Inc.), the results collectively demonstrate that preservation strategies designed to actively control key physiological variables can help improve post-transplant outcomes.

In a multi-center analysis of 499 adult lung transplant recipients across 18 transplant centers between February 2021 and April 2025, outcomes were evaluated based on preservation temperature ranges between 4°C and 10°C in the LUNGguard Donor Lung Preservation System. Lungs preserved within a controlled 6°C-8°C range demonstrated the lowest rates of post-transplant rejection and intervention burden, even in cohorts characterized by longer ischemic times and higher risk donor characteristics, including statistically significant reductions in:

• Reduced use of pulmonary vasodilators (p<0.003) 
• Lower rates of antibody-mediated rejection treatment (p<0.010) 
• Less need for bronchoscopic intervention (p<0.047) 

In contrast, lungs preserved within a controlled 8°C-10°C range demonstrated less favorable clinical outcome profiles. Notably, these outcomes were observed despite more favorable baseline characteristics in this cohort, including fewer donation after circulatory death (DCD) donors, fewer single lung transplants, and shorter transport distances, factors typically associated with improved outcomes. 

Additional analysis showed that maintaining donor lungs within this window of 6°C-8°C for more than 70% of preservation time improved outcomes, reinforcing the importance of consistency within a controlled range rather than targeting a single temperature. 

Clinical investigators also evaluated the impact of adding controlled airway pressure through the BAROguard System. Despite being utilized in more complex clinical scenarios, including significantly longer ischemic times (p=0.033) and a greater proportion of time-shifted cases (p=0.008), the BAROguard cohort demonstrated:

• Significantly less need for post-transplant mechanical support (p<0.001)
• Significant reductions in airway inflammation at discharge (p=0.012)​
• Significant reduction in airway inflammation in hospital through the first-year post-transplant (p=0.021) 

These findings suggest that active airway pressure management may play a critical role in mitigating preservation-related injury, particularly in higher-risk transplant scenarios, according to Paragonix Technologies. 

In subgroup analyses of cases involving transport distances greater than 500 nautical miles, used as a surrogate for air travel, BAROguard continued to demonstrate improved clinical performance despite longer ischemic times and more complex donor profiles. Statistically significant outcomes in this cohort included:

• Less need for post-transplant mechanical support (p<0.001)
• Less airway inflammation at discharge (p=0.015) 
• A 24% reduction in median hospital length of stay (p=0.039)  
• A 31% increase in Textbook Outcomes (p=0.036)  

These findings highlight the importance of actively managing airway pressure during transport, particularly during flight conditions where fluctuations in ambient pressure may contribute to organ injury. 

“These data reinforce a fundamental shift in how lung preservation should be approached,” said Dr. Nathaniel Langer, GUARDIAN-Lung Investigator and surgical director of Lung Transplantation at Massachusetts General Hospital. “Technologies designed to actively manage both temperature and airway pressure are demonstrating measurable and consistent clinical advantages across a wide range of transplant conditions.”

Paragonix Technologies, a Getinge company, is striving to redefine the way donor organs are protected and delivered, setting a new standard of care for transplantation worldwide. The company partners with transplant centers and OPOs to improve outcomes through clinically proven preservation technologies and expert, hands-on procurement support. Paragonix Technologies’ nationwide transplant services provide 24/7 access to surgical recovery teams, logistics coordination, and clinical excellence— streamlining the recovery process and expanding access to life-saving organs. Combined with real-time digital monitoring, transparent data sharing, and the world’s largest preservation-focused clinical registries, Paragonix aims to deliver every possible advantage to healthcare providers and patients.