A 20-Year Retrospective Analysis Shows Differential Predictors in Lung Procurement Between DCD and DBD Donors

Abstract

<h3>Purpose</h3> While literature reports similar survival outcomes of DBD and DCD transplants, research should investigate improvements to DCD lung recovery protocols to increase the total number recovered. Recently, Choi et al. presented donor variables indicative of DCD lung recovery. However, expansion of DCD lung transplants requires comparison of these indicators to DBD donors for application of similar parameters to increase the rate of DCD lung recovery. <h3>Methods</h3> We performed a retrospective analysis of UNOS data from the SRTR. Donors who donated ≥1 organ from 10/1999-01/2019 were extracted and stratified according to DBD and DCD status. Associated characteristics of potential DCD and DBD lung donors were compared and a multivariable logistic regression model with ≥1 transplanted lung was constructed to evaluate the independent effects of important predictors. <h3>Results</h3> Our data included 179,228 potential lung donors, 162,157 DBD (31,486 donated, 19.4% recovery) and 17,071 DCD (526 donated, 3.1% recovery). Odds of lung nonuse between DBD and DCD donors were significantly associated with blood type, alcohol use, infection, cause of death, smoking history, drug use, death circumstance, ethnicity, gender, hypertension, insulin dependence, intracranial cancer, age, and lung pO2 on 100% P/F ratio (P <.001 for all variables). A multivariable regression analysis showed that donors' who died from MVA or drowning were 0.27 [95% 0.13, 0.53, p<0.001] and 7.13 [95% 2.56, 19.85, p<0.001] times less likely, respectively, to have their lungs procured in DCD vs DBD. Lungs from donors ages 40-49 are more likely to be procured than those <30 or >50 in both DBD and DCD. However, likelihood of procurement is 1.84 [95% 1.42, 2.38, p<0.001] times higher in 40-49-year-old vs. <30-year-old donors when comparing DBD vs. DCD, and 2.43 [95% 1.83, 3.22, p<0.001] times higher than patients >50 in DBD vs DCD donors. In addition, for each era, the odds for procuring DCD vs. DBD lungs consistently improved [95% 1.46-2.57, p<0.001]. <h3>Conclusion</h3> Despite literature reporting comparable survival of DCD and DBD organs, this study highlights discrepancies in lung procurement practices which evaluate donor characteristics differently in DBD and DCD donors. Further study should investigate if similar discrepancies exist in the procurement process of other organs.