Donation after circulatory death in lung transplantation-five-year follow-up from ISHLT Registry.

Van Raemdonck, Dirk and Keshavjee, Shaf and Levvey, Bronwyn and Cherikh, Wida S and Snell, Greg and Erasmus, Michiel and Simon, André and Glanville, Allan R and Clark, Stephen and D'Ovidio, Frank and Catarino, Pedro and McCurry, Kenneth and Hertz, Marshall I and Venkateswaran, Rajamiyer and Hopkins, Peter and Inci, Ilhan and Walia, Rajat and Kreisel, Daniel and Mascaro, Jorge and Dilling, Daniel F and Camp, Philip and Mason, David and Musk, Michael and Burch, Michael and Fisher, Andrew and Yusen, Roger D and Stehlik, Josef and Cypel, Marcelo (2019) Donation after circulatory death in lung transplantation-five-year follow-up from ISHLT Registry. The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation, 38 (12). pp. 1235-1245. ISSN 1557-3117. This article is available to all UHB staff ans students via ASK Discovery tool http://tinyurl.com/z795c8c by using their UHB Athens login IDs

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Official URL: https://www.jhltonline.org/article/S1053-2498(19)3...

Abstract

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.

Item Type: Article
Additional Information: This article is available to all UHB staff ans students via ASK Discovery tool http://tinyurl.com/z795c8c by using their UHB Athens login IDs
Subjects: WF Respiratory system. Respiratory medicine
WO Surgery
Divisions: Planned IP Care > Respiratory Medicine
Related URLs:
Depositing User: Jamie Edgar
Date Deposited: 06 Dec 2019 15:54
Last Modified: 12 Dec 2019 13:50
URI: http://www.repository.uhblibrary.co.uk/id/eprint/2665

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