A multicenter analysis of lung transplantation outcomes comparing donation after circulatory death and donation after brain death

Abstract

BackgroundDonor organ shortage is a barrier to lung transplantation. Donation after circulatory death (DCD) may offer a solution, although it is underutilized. The objective of this study was to compare survival and other postoperative outcomes between DCD and donation after brain death (DBD). MethodsWe performed a multi-center analysis of Multi-Institutional Extracorporeal Life Support (ECLS) Registry data from 11 lung transplant centers in the United States and Europe. Demographics and clinical parameters were compared using Chi-square test and Fisher's exact test. Survival was assessed by Kaplan-Meier curves and compared by log-rank test with propensity score matching. ResultsOf 1585 patients included in the study, 135 (8.5%) received DCD lungs and 1450 (91.5%) received DBD lungs. DCD recipients had higher rates of obstructive lung disease (p=0.042), longer total ischemic time (p<0.0001), and higher rates of primary graft dysfunction (PGD) at t0h (p<0.0001) and t24h (p=0.0005). PGD at t48h and t72h was not significantly different between DCD and DBD recipients. 90-day survival was lower among DCD recipients (91.2%) compared to DBD recipients (97.4%, p=0.038). Survival was higher without ECLS (p=0.014), whereas EVLP (p=0.47) did not affect survival. ConclusionOverall, our data showed excellent 90-day survival for DCD and DBD recipients, although DCD recipients had relatively lower survival. EVLP was not associated with survival, which may guide future strategies to optimize DCD utilization.