Selected Abstracts from ISHLT 2026 - Traferox Technologies Inc.

It was great to connect at ISHLT 2026 in Toronto. Whether you dropped by our booth or joined our symposium, it was a pleasure to interact with so many lung and heart transplant professionals from around the world.

This year’s meeting highlighted the growing body of evidence for extended preservation and the real-world clinical impact of 10°C preservation for both heart and lung transplantation. The meeting also featured compelling research leveraging the TorEx EVLP system, demonstrating its role in data-driven lung assessment, outcome prediction, and the development of novel therapeutics.

10°C Lung Preservation Abstracts

6 abstracts

Extended Donor Lung Preservation Beyond 24 Hours Yields Acceptable Outcomes Using 10°C Static Preservation: First Clinical Experience from Two High Volume North American Centers

J. Montagne, M. Cerullo, Y. Suzuki, C. Demarest, G. Garza, J. Yeung, et al.

University Health Network, Toronto, Canada; Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt University Medical Center, Nashville, TN; University of Toronto, Toronto, Canada

17 donor lungs preserved at 10°C with reperfusion beyond 24 hours were evaluated for early clinical experience and short-term outcomes. None of the patients developed PGD3 at 72h, median length of mechanical ventilation was 2 days, median ICU LOS was 5 days, median hospital LOS was 36 days and 30-day survival was 100%. Prolonged cold static preservation of donor lungs at 10°C beyond 24h appears safe and does not adversely affect short- to intermediate-term outcomes.

Clinical Impact of Duration of Second Cold Ischemic Time at 10°C After Ex Vivo Lung Perfusion

J. Montagne, A. Wang, A. Mariscal, G. Loesch Siebiger, G. Garza, P. Oliveira, et al.

University Health Network, Toronto, Canada; Toronto General Hospital Research Institute, Toronto, Canada; UHN, Toronto, Canada; University of Toronto, Toronto, Canada; Toronto General Hospital, Toronto, Canada

In 140 lung transplants, grafts were categorized into three groups based on the second cold ischemic time (CIT2) at 10°C after ex vivo lung perfusion (EVLP): Short (<350 min, n=45), Medium (351–500 min, n=44), and Long (>501 min, n=51). Extending the second cold ischemic time (CIT2) at 10°C up to 17 hours did not affect early outcomes, including PGD3 at 72 hours (Short: 11.11%, Medium: 13.64%, Long: 11.76%; p=0.931), ICU stay (p=0.143), time to extubation (p=0.659), or 90-day survival (p=0.504). This data supports the safe extension of CIT2 at 10°C after EVLP, providing logistical flexibility and expanding opportunities for successful lung transplantation.

Post-Reperfusion Metabolic Implications of 10°C Static Preservation of Donor Lungs

M. Martinez Santos, A. Wang, A. Ali, M. Liu, S. Keshavjee, M. Cypel

University of Toronto, Toronto, Canada; Latner Thoracic Research Laboratories, Toronto General Hospital Research Institute, Toronto, Canada

Porcine donor lungs (n=5/group) were randomized to 36h of CIT on ice or 10°C, and subsequently subjected to 12h of ex vivo lung perfusion (EVLP). 10°C preservation induced a greater reactivation of cytoprotective and energy conserving pathways, decreased urea cycle activity, and greater capacity for aerobic respiration. Extended 10°C preservation primes lungs for superior metabolic recovery and allograft resilience during EVLP, likely contributing to reduced ischemia reperfusion injury and improved outcomes.

Enhancement of Organ Preservation Solution with Lipid-Based Energy Substrates Optimize 10°C Donor Lung Preservation

P. Melo, J. Yune, Y. Zhang, G. Loesch Siebiger, G. Garza, M. Bosone, et al.

Latner Thoracic Research Laboratories, Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, Canada

Porcine donor lungs (n=5/group) were randomly assigned to 24 hours of static 10°C preservation with low potassium dextran (LPD) solution or LPD plus a lipid emulsion (LPD+SMOF; 10%). Uniform upregulation of markers reflecting mitochondrial quality control were observed. Lipid supplementation of LPD enabled cellular processes to improve graft quality during hypothermic preservation at 10°C.

10°C Heart Preservation Abstracts

5 abstracts

Cooler Isn’t Better: 10°C Storage Outperforms 4–8°C Preservation with Lower Primary Graft Dysfunction and Improved Outcomes

A. Williams, B. Lima, A. Ahmad, A. Benkert, S. Bommareddi, J. Trahanas, et al.

Vanderbilt University Medical Center, Nashville, TN; Duke University Hospital, Durham, NC; Vanderbilt University School of Medicine, Nashville, TN

A retrospective study across two high-volume centers compared peri-transplant outcomes between 113 10°C static cold storage (SCS) and 252 4–8°C SCS preserved heart allografts. Propensity-matched analysis showed 10°C SCS was associated with significantly lower rates of severe PGD (2.9% vs 14.6% p=.003), LV dysfunction (10% vs 38%, p < .001), RV dysfunction (0% vs 6.9%, p = .003), and the need for IABP (2.9% vs 22%, p < .001). 10°C SCS may enhance myocardial ischemic tolerance and improve post-transplant outcomes versus 4–8°C SCS, supporting its potential to redefine cardiac allograft preservation standards.

Enhanced Myocardial Performance After Heart Transplantation with 10°C Static Cold Storage: A Real-Time Hemodynamic Analysis

A. Ahmad, C. Wang, M. Petrovic, J. Trahanas, S. Bommareddi, T. Absi, et al.

Vanderbilt University Medical Center, Nashville, TN; Vanderbilt University School of Medicine, Nashville, TN

Among 478 heart transplant recipients, 207 allografts were preserved using 10°C SCS and 271 using ice. Despite significantly longer ischemic times (237 vs 201 min, p <.001), 10°C SCS preserved early biventricular power more effectively than ice with higher 12-hour nadir CPOI-VIS (6.59 vs 6.25, p = .01) and RV-CPO (0.24 vs 0.21, p = .001). These findings suggest that 10°C preservation may mitigate ischemic injury and enhance post-transplant myocardial performance.

10°C Storage Preserves Metabolic Reserve and Reduces Oxygen Debt in Heart Transplantation

A. Ahmad, C. Wang, M. Petrovic, J. Trahanas, S. Bommareddi, T. Absi, et al.

Vanderbilt University Medical Center, Nashville, TN; Vanderbilt University School of Medicine, Nashville, TN

In 332 heart transplant recipients (194 at 10°C vs 138 ice), 10°C storage was independently associated with a 36% lower post-clamp O₂ER burden, corresponding to an average reduction of 52% in reperfusion O₂ER burden compared to ice. Overall, 10°C SCS reduces O₂ER burden even in higher-risk grafts, supporting improved metabolic preservation and reduced ischemia-reperfusion injury compared to ice.

Tick Tock Goes the Clock: Normothermic Machine Perfusion versus Static Cold Storage at 10°C for Extended Preservation of Cardiac Allografts

S. Patlolla, A. Ahmad, C. Wang, M. Petrovic, B. Lima, S. Bommareddi, et al.

Mayo Clinic, Rochester, MN; Vanderbilt University Medical Center, Nashville, TN; Vanderbilt University School of Medicine, Nashville, TN; Mayo Clinic, Rochester, MN

Patients that received allografts transported utilizing normothermic machine perfusion (NMP) (n=32) or 10°C static cold storage (n=38) were compared. Both preservation techniques appear to yield similar post-transplant survival, with a non-significant trend towards higher incidence of severe primary graft dysfunction in the NMP group (9.4% vs 2.6%; p=0.32). The differences observed in cardiac function, incidence of PGD and graft rejection need further investigation with larger samples.

The Fall of the Machines: 10°C Static Storage Provides Superior Myocardial Preservation Compared to Normothermic Machine Perfusion

A. Williams, B. Lima, A. Ahmad, A. Bankert, J. Trahanas, S. Bommareddi, et al.

Vanderbilt University Medical Center, Nashville, TN; Duke University Hospital, Durham, NC; Vanderbilt University School of Medicine, Nashville, TN; Duke University Medical Center, Durham, NC

A retrospective study across two high-volume centers compared peri-transplant outcomes between 113 10°C static cold storage (SCS) cases and 79 normothermic machine perfusion (NMP) cases. Propensity-matched analysis showed 10°C SCS was associated with significantly lower rates of severe PGD (3.3% vs 16.7%), LV dysfunction (11.5% vs 41.7%, p < .001), RV dysfunction (0% vs 16.7%, p < 0.001), and the need for IABP (3.3% vs 33.3%, p < .001). Overall, 10°C SCS demonstrated superior myocardial protection and early graft recovery compared to NMP, even in prolonged ischemic time.

Lung Perfusion & Assessment Abstracts

6 abstracts

Predicting Post-Transplant FEV1 Using Donor Lung Function Measured During EVLP with Machine Learning

D. Piyasena, S. Hacker, H. Ahmed, X. Zhou, M. Wei, N. Sawal, M. Cypel, A. Sidhu, T. Martinu, S. Keshavjee, A. Sage

University Health Network, Toronto, ON, Canada; Toronto General Hospital, Toronto, ON, Canada

Machine learning models leveraging donor lung function measured during EVLP can accurately forecast post-transplant FEV1 with the best reported performance to date. Mean absolute error (MAE) and the mean absolute percentage error (MAPE) were 0.37±0.06L and 16.9±3.8% respectively. Donor lung elastance measured during EVLP was the single most important feature influencing post-transplant FEV₁ predictions.

A Machine Learning Algorithm to Quantify the Impact of Smoking in Donor Lungs Assessed on Ex Vivo Lung Perfusion

L. Ronen, S. Hacker, T. Borrillo, D. Rozenberg, L. Del Sorbo, M. Cypel, S. Keshavjee, A. Sage

University Health Network, Toronto, ON, Canada

This study presents a novel approach to analyzing high-resolution breath profiles from EVLP, assessing the physiological impact of smoking on donor lung quality. A machine learning algorithm, termed the ‘Smoking Impact Index’ (SII) provides a quantitative metric that can assist in selecting donor lungs for transplant. The SII achieved an accuracy of 92.5% and an area under the receiver operating characteristic curve of 90%.

Using Artificial Intelligence and Machine Learning to Improve Selection of Donor Lungs for Ex Vivo Lung Perfusion

H. Ahmed, D. Piyasena, T. Waddell, M. Cypel, S. Keshavjee, A. Sage

Latner Thoracic Research Laboratories, University Health Network, Toronto, ON, Canada; Toronto General Hospital, Toronto, ON, Canada; UHN, Toronto, ON, Canada

This ML tool shows strong potential to support early triage by identifying donor lungs that are strong candidates for EVLP reconditioning. The EVLP candidacy model achieved an AUC of 77 ± 3%. Key characteristics of EVLP candidates identified by the model included donor PaO₂, concern for pneumonia, and aspiration history.

Towards Digital Twins of Ex Vivo Human Lungs for Restrictive and Obstructive Lung Diseases Using Machine Learning

S. Hacker, L. Del Sorbo, X. Zhou, Y. Wei, T. Borrillo, M. Cypel, B. Wang, S. Keshavjee, A. Sage

Latner Thoracic Research Laboratories, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada; Department of Computer Science, University of Toronto, Toronto, ON, Canada

EVLP-based digital twins effectively capture trends in key respiratory parameters of lungs with disease-like phenotypes. This research developed virtual replicas simulating lungs with chronic obstructive pulmonary disease (COPD) and idiopathic pulmonary fibrosis (IPF) on ex vivo lung perfusion (EVLP).

Safe and Efficient Endothelial Gene Transfection Using Lipid Nanoparticles During Ex Vivo Lung Perfusion

J. Yune, P. Melo, G. Loesch Siebiger, Y. Zhang, A. Nagoya, A. Strilchuk, X. Yue, X. Fu, S. Juvet, M. Liu, L. Bowen, S. Keshavjee, M. Cypel, A. Wang

Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada; Department of Pharmaceutical Sciences, University of Toronto, Toronto, ON, Canada

A lipid nanoparticle (LNP) formulation enabled efficient, endothelial-specific gene delivery in a rat EVLP model without affecting lung function or increasing inflammatory markers. The endothelial-specific transfection rate was 65.3% ± 3.01 at 3 μg mCherry mRNA/mL. These results demonstrate safe and effective LNP-based delivery of genetic payload to donor lungs during EVLP.

Membraneless EVLP Maintains Stable Lung Function in a Gastric Juice Injured Pig Model

G. Garza, A. Wang, J. Yune, J. Montagne, N. Furie, P. Melo, Y. Zhang, G. Loesch Siebiger, F. O. Gao, L. Del Sorbo, M. Liu, S. Keshavjee, M. Cypel

Latner Thoracic Research Laboratories, Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, ON, Canada

In a porcine model (n=5/group) of aspiration-injured donor lungs, cellular membraneless EVLP maintained stable function over 12 hours, whereas 4/5 lungs in the standard EVLP group deteriorated in function and met termination criteria before 12h. Membraneless EVLP also showed lower lactate and cytokine levels, supporting its potential as a superior platform for preserving and rehabilitating injured donor lungs.