(857) - Lung Transplantation from Donation after Circulatory Determined Dead (DCD) Donors: A Single Centre Experience

Abstract

Donor organ shortage still remains the major limitation in lung transplantation (LT). The Donation after Circulatory determined Dead (DCD) donor has been successfully adopted as a source of additional donor lungs worldwide. However, concerns about organ quality and ischemia-reperfusion injury have limited the application. The aim of this study is to analyze the 6 year experience of our transplant unit in LT from controlled Maastricht category III donors and to compare early and mid-term outcome with standard donation after brain dead (DBD) donor. Data was entered prospectively into a dedicated transplant database. Analysis was performed retrospectively for the period between March 2009 and March 2015. Continuous variables were tested with Mann-Whitney’s test; categorical variables with Fisher’s test. During this period 186 LT were performed: 147 bilateral LT (79%) and 39 single LT (21%). Of these, 23 recipients received organs retrieved from DCD donors (12.4%). No differences were found between the 2 groups of donors regarding age, gender, history of smoking, mechanical ventilation time, cause of death, and total mean cold ischaemic time. In the DCD group, the mean time from withdrawal to declaration of death was 14.9±6.9 min and the mean warm ischaemic time from death to pneumoplegia was 20.5±6.8 min. There were no differences in recipient characteristics except for age (58.1±7.4 for DCD compared with 50.4±13.7 in the DBD group, p=.009) and cystic fibrosis as underlying disease (19.6% for DBD compared with no patients in the DCD group, p=.02). The DCD group was comparable to the DBD group in terms of duration of mechanical ventilation, incidence of ECMO for severe primary graft dysfunction (PGD), intensive care unit and hospital length of stay. PGD rate and grade were not different between groups at 24 and 72 hours after LT. No differences in airway anastomotic complications, incidence and grading of rejection and freedom from BOS were recorded. Actuarial survival rate in the subgroup of bilateral LT at 1 and 5 years was 75% and 51% for the DCD group and 82% and 61% for the DBD group (p=.12). Short- and medium-term outcome after DCD LT is comparable with LT from DBD donors, despite a tendency to use DCD lungs for older recipients. Therefore, DCD LT is a clinical reality that can be used safely in selected recipients to expand the lung donor pool.