326 A Randomized Trial of Nebulized Albuterol To Enhance Resolution of Pulmonary Edema in 506 Brain Dead Organ Donors

Abstract

Purpose: To review our experience after 5 years of lung transplantation (LTx) using lung donation after cardiac death (DCD). Methods and Materials: Outcomes DCD LTx were compared with contemporaneous recipients receiving lungs from brain death donors(BDD). Incidence of severe primary graft dysfunction(PGD), ICU and hospital length of stay(LOS), 30 day mortality, and overall survival were analyzed. Results: During the study period, 448 LTx were performed; 408 from BDD and 40 from DCD donors. The proportion of DCD donors among cadaveric donors and the proportion lung transplants using DCD donors are shown in Figure 1. Recipient diagnosis was similar in both groups (BDD vs. DCD): Emphysema (26% vs. 30%), pulmonary fibrosis (33% vs. 32%), cystic fibrosis (20% vs. 23%), and others (22% vs. 14%). Median donor P/F was 422 mmHg in BDD group and 360 mmHg in DCD group (p 0.004). Median recipient P/F at ICU arrival was 350 mmHg in BDD vs. 301 mmHg in DCD (p 0.06). Incidence of severe primary graft dysfunction after LTx requiring ECMO support was 2.7% in BDD and 7.5% in DCD (p 0.14). Median ICU stay was 4 days in BDD and 5 days in DCD. Median hospital LOS was 23 days in both groups (p 0.05). 30 day, 1 year and 3 year proportional survival were 95.7%, 84%, and 70% in BDD and 95%, 85%, and 64% in DCD respectively (P 0.05 for all comparisons). Within the DCD group, 18 lungs underwent ex vivo lung perfusion (EVLP). Lungs undergoing EVLP had decreased incidence of PGD 3 at 72h after LTx: 0 vs 22% (p 0.04). Conclusions: Lung transplantation using DCD donors currently accounts for 15-20% of our LTx activities. The use of controlled DCD lungs is associated with similar clinical outcomes as LTx using BDD donors. EVLP led to decreased incidence of severe PGD in the DCD population.