(69) - Controlled Donation after Circulatory Death (DCD) Donors and Pediatric Lung Transplant (pLTx): Enhanced Opportunities and Excellent Outcomes

Abstract

Access to timely suitably sized matched quality organs has been a challenge for LTx, and pLTx in particular. DCD lungs are increasingly providing such organs for adult LTx (aLTx)- up to 30% in some centers, however the utility and outcomes of DCD pLTx have not been described. This report describes our centers controlled DCD and pLTx activity (<age 18 yrs) and outcomes since our first adult DCD donors and aLTx in 2006- including subsequently our first pLTx DCD donor in 2007 and first pediatric DCD LTx in 2012. Ex-vivo Lung Perfusion was not used. 27 pLTx have been performed since 2006 utilizing 6 DCD and 21 donation after brain death (DBD) donors. Since 2012, 6 of the 9 pLTx have utilized DCD. The 6 included 2 pediatric DCD donors (median age 10yrs), 2 adult cutdown bilobar and 2 adult complete DCD donors (med age 45yrs) with a mean wait-list (W/L) time of 83 days, median 21d. The other 3 pLTx utilized DBD donors- 1 pediatric (age 8yrs), 1 adult bilobar cut down and 1 adult intact (ages 45 & 29 yrs) with a mean W/L time of 143d, median 66d. The 6 pLTx recipients of DCD lungs were median age 15 years with cystic fibrosis (n=4) and pulmonary hypertension (n=2, with 1 on ECMO). All 9 pLTx are alive at a median of 487d. 1 patient is BOS 2. There was 1 W/L death (182d) in 2013- a sensitized potential re-LTx age 16yrs. Since 2006 an additional 10 pediatric DCD donors (median age 16yrs) have been used for aLTx, 7 since 2012. The 10 adult recipient LTx indications included COPD (n=4), cystic fibrosis/bronchiectasis (n=3), reLTx, ILD and pulmonary hypertension (n=1 each), with a mean age of 46 yrs and W/L time of 230d, median 97d. All these 10 aLTx are alive at a median of 1320d. 1 patient is BOS 1 and 1 BOS 3. Controlled DCD provide a significant and quality donor lung pool to increase LTx opportunities for pediatric patients with severe lung disease. With lives at stake, and only in the appropriate legal/organizational framework, it is now time for all pLTx and aLTx centers to consider and embrace DCD.