Background: This study aimed to examine intermediate-term outcomes of lung transplantation (LTx) recipients from donors after circulatory death (DCD). Methods: We examined the International Society for Heart and Lung Transplantation (ISHLT) Thoracic Transplant Registry data for patients transplanted between January 2003 and June 2017 at 22 centers in North America, Europe, and Australia participating in the DCD Registry. The distribution of continuous variables was summarized as median and interquartile range (IQR) values. Wilcoxon rank sum test was used to compare distribution of continuous variables and chi-square or Fisher's exact test for categorical variables. Kaplan-Meier survival rates after LTx from January 2003 to June 2016 were compared between DCD-III (Maastricht category III withdrawal of life-sustaining therapy [WLST]) only and donors after brain death (DBD) using the log-rank test. Risk factors for 5-year mortality were investigated using Cox multivariate proportional-hazards model. Results: The study cohort included 11,516 lung transplants, of which 1,090 (9.5%) were DCD lung transplants with complete data. DCD-III comprised 94.1% of the DCD cohort. Among the participating centers, the proportion of DCD-LTx performed each year increased from 0.6% in 2003 to 13.5% in 2016. DCD donor management included extubation in 91%, intravenous heparin in 53% and pre-transplant normothermic ex vivo donor lung perfusion in 15%. The median time interval from WLST to cardiac arrest was 15 minutes (IQR: 11-22 minutes) and to cold flush 32 minutes (IQR: 26-41minutes). Compared with DBD, donor age was higher in DCD-III donors (46 years [IQR: 34-55] vs 40 years [IQR: 24-52]), bilateral LTx was performed more often (88.3% vs 76.6%), and more recipients had chronic obstructive pulmonary disease and emphysema as their transplant indication. Five-year survival rates were comparable (63% vs 61%, p = 0.72). In multivariable analysis, recipient and donor ages, indication diagnosis, procedure type (single vs bilateral and double LTx), and transplant era (2003-2009 vs 2010-2016) were independently associated with survival (p < 0.001), but donor type was not (DCD-III vs DBD; hazard ratio, 1.04 [0.90-1.19], p = 0.61). Conclusion: This ISHLT DCD Registry report with 5-year follow-up demonstrated similar favorable long-term survival in DCD-III and DBD lung donor recipients at 22 experienced centers globally. These data indicate that more extensive use of DCD-LTx would increase donor organ availability and may reduce waiting list mortality.
Bibliographical noteFunding Information:
S.K. and M.C. are founders and shareholders of XOR Labs Toronto and Perfusix Canada and are consultants for Lung Bioengineering, Inc, Silverspring, MD. D.V.R and M.I.H. are members of the OCS Lung advisory board of Transmedics, Andover, MA. D.F.D received clinical trial research support from Lung Bioengineering, Inc, Silverspring, MD. D.K. has a pending patent entitled “Compositions and methods for detecting CCR2 receptors.” None of the other authors have conflicts of interest to disclose. The authors would like to thank Aparna Sadavarte, MS from the United Network for Organ Sharing in Richmond, VA for preparing the analysis datasets for this manuscript. The authors acknowledge the contribution of all data coordinators at the 22 participating institutions. The authors are grateful to Sally Rushton for her tremendous help in transferring data from the National Health Service Blood and Transplant in the United Kingdom into the United Network for Organ Sharing database. The DCD Registry has been funded by the International Society for Heart and Lung Transplantation, Dallas, TX. Paper was presented at the 2019 Annual Meeting and Scientific Sessions of the International Society for Heart and Lung Transplantation, Orlando, FL, April 3-6, 2019.
© 2019 International Society for Heart and Lung Transplantation
- donor lung allograft
- donors after circulatory death
- lung transplantation
- mortality risk factors