Donation after Circulatory Death (DCD): A 10-Year Experience in Bilateral Lung Allograft Survival at a Single Australian Center

Abstract

Purpose Early and intermediate lung transplant outcomes for DCD are equivalent to donation-after-brainstem-death. Our aim is to describe long-term graft survival for lung transplant recipients since the implementation of DCD. Methods A retrospective cohort analysis was conducted of all bilateral lung transplant patients at a single center between Nov-2007 and Sep-2018. The method of donation was collected for all recipients in additional to baseline surgical co-variates. The mechanism of death in DCD donation were categorised into cerebrovascular event, hypoxic injury and trauma. Graft survival was defined as the time to death or retransplantation. For survival analysis, Kaplan-Meier curves were generated for the donation type and compared using the Log Rank test. Results 485 patients underwent bilateral lung transplant during the study period. 98 patients received a DCD donor and 387 patients received a DBD donor. There were no significant differences between the groups in recipient age, donor age, pre-explantation donor PaO2, % CMV mismatch, recipient BMI or length of hospital stay for transplant admission. There were no significant differences in the proportions of native lung disease, except for a greater number of patients with pulmonary hypertension in the DCD group (9.2 vs 1.6%, p Conclusion There was no significant difference in the long-term graft survival benefit gained from bilateral lung transplantation depending on the mode of donation (DCD vs DBD). Our experience confirms that DCD donation is a viable mode of donation which serves to increase recipient access to transplantation with no apparent decrease in long-term post-transplant survival.