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

作者：Mohammed Abul Kashem, Gabriel Loor, Matthew Galen Hartwig, Dirk E. Van Raemdonck, Mauricio A. Villavicencio, Fabio Ius, Kamrouz Ghadimi, Jawad Salman, Satish Chandrashekaran, Tiago Machuca, Pablo Gerardo Sánchez, Kathirvel Subramaniam, Arne Neyrinck, Hannah R. Calvelli, Michael Warnick, Huaqing Zhao, Stephen J. Huddleston, Asishana Avo Osho, Ethan D'Silva, Uma Ramamurthy, Andres Leon Pena, Marcelo Salan‐Gomez, Andrew W. Shaffer, Nathaniel B. Langer, Amir M. Emtiazjoo, Yoshiya Toyoda · 发表于：JHLT Open · 年份：2024 · DOI：10.1016/j.jhlto.2024.100132 · 被引用次数：9 · 研究领域：Transplantation: Methods and Outcomes、Organ Donation and Transplantation、Organ Transplantation Techniques and Outcomes

Background 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). Methods 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. Results 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. Conclusions 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 ...