Effect of an intensive lung donor-management protocol on lung transplantation outcomes

• Published in: The Journal of heart and lung transplantation Vol. 33; no. 2; pp. 178 - 184
• Main Authors: Miñambres, Eduardo, MD, PhD, Coll, Elisabeth, MD, Duerto, Jorge, MD, Suberviola, Borja, MD, PhD, Mons, Roberto, MD, PhD, Cifrian, José Manuel, MD, Ballesteros, Maria Angeles, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-02-2014
• Subjects: Adult; Aged; Brain Death; Cohort Studies; donor management; donors after brain death; Humans; lung transplantation; Lung Transplantation - mortality; Male; Middle Aged; Outcome Assessment (Health Care); procurement rate; Prospective Studies; Retrospective Studies; Surgery; survival; Survival Rate; Tissue and Organ Procurement - standards; Tissue Donors; lung transplantation; donors after brain death; survival; donor management; procurement rate
• ISSN: 1053-2498; 1557-3117
• DOI: 10.1016/j.healun.2013.10.034

Background An intensive lung donor-management protocol based on a strict protocol would increase the lung procurement rate. The aim of this study was to determine the effect of such a protocol on the rate of lung grafts available for transplant. Methods A lung-management protocol for donors after brain death (DBD) was implemented in 2009. Lung donors from 2009 to 2011 were the prospective cohort, and those from 2003 to 2008 formed the historical control. We analyzed the synergic effect of several measures, such as protective ventilation, ventilator recruitment maneuvers, high positive end-expiratory pressure, fluid restriction with reduced extravascular lung water values, and hormonal resuscitation therapy in multiorgan DBD. The number of lungs available for transplantation was the main outcome measure. For recipients, early survival and the rate of primary graft dysfunction (PGD) grade 3 were the main outcome measures. Results The DBD rate was more than 40 donors per 1 million population in both periods. The rate of lung donors increased from 20.1% to 50% ( p < 0.001), quadrupling the number of lung donors ( p < 0.001), grafts retrieved ( p = 0.02), and patients who received a lung transplant ( p < 0.01). No differences were observed in the survival of early recipients ( p = 0.203) or in the rate of PGD grade 3 ( p = 0.835). Conclusion The management of multiorgan DBDs should be approached as a global treatment requiring attentive bedside management. Implementing an intensive lung donor-management protocol based on synergic measures increases lung procurement rates, negative effect on early survival of lung recipients or PGD grade 3.