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

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 survival, which may guide future strategies to optimize DCD utilization.