A multicenter analysis of lung transplantation outcomes comparing donation after circulatory death and donation after brain death

• Published in: JHLT open Vol. 6; p. 100132
• Main Authors: Abul Kashem, Mohammed, Loor, Gabriel, Hartwig, Matthew, Van Raemdonck, Dirk, Villavicencio, Mauricio, Ius, Fabio, Ghadimi, Kamrouz, Salman, Jawad, Chandrashekaran, Satish, Machuca, Tiago, Sanchez, Pablo G., Subramaniam, Kathirvel, Neyrinck, Arne, Calvelli, Hannah, Warnick, Michael, Zhao, Huaqing, Huddleston, Stephen, Osho, Asishana, D'Silva, Ethan, Ramamurthy, Uma, Pena, Andres Leon, Salan-Gomez, Marcelo, Shaffer, Andrew, Langer, Nathaniel, Emtiazjoo, Amir, Toyoda, Yoshiya
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01-11-2024; Elsevier
• Subjects: donation after brain death; donation after circulatory death; lung transplant; outcomes; survival; donation after brain death; donation after circulatory death; lung transplant; outcomes; survival
• ISSN: 2950-1334; 2950-1334
• DOI: 10.1016/j.jhlto.2024.100132

Donor organ shortage is a barrier to lung transplantation. Donation after circulatory death (DCD) may offer a solution, although it is underutilized. The objective of this study was to compare survival and other postoperative outcomes between DCD and donation after brain death (DBD).
We performed a multicenter analysis of Multi-Institutional Extracorporeal Life Support (ECLS) Registry data from 11 lung transplant centers in the United States and Europe. Demographics and clinical parameters were compared using chi-square test and Fisher's exact test. Survival was assessed by Kaplan-Meier curves and compared by log-rank test with propensity score matching.
Of 1,585 patients included in the study, 135 (8.5%) received DCD lungs and 1,450 (91.5%) received DBD lungs. DCD recipients had higher rates of obstructive lung disease (p = 0.042), longer total ischemic time (p < 0.0001), and higher rates of primary graft dysfunction (PGD) at t0h (p < 0.0001) and t24h (p = 0.0005). PGD at t48h and t72h was not significantly different between DCD and DBD recipients. Ninety-day survival was lower among DCD recipients (91.2%) compared to DBD recipients (97.4%, p = 0.038). Survival was higher without ECLS (p = 0.014), whereas ex vivo lung perfusion (EVLP) (p = 0.47) did not affect survival.
Overall, our data showed excellent 90-day survival for DCD and DBD recipients, although DCD recipients had relatively lower survival. EVLP was not associated with survival, which may guide future strategies to optimize DCD utilization.