Effect of Lung Protective Ventilation in Organ Donors on Lung Procurement and Recipient Survival: Results from a Nationwide Cohort Study

Abstract

Purpose Previous studies have shown that lung protective strategy in selected potential organ donors after brain death (DBD) increased lung eligibility and procurement. This prospective nationwide cohort study aimed to evaluate the impact of lung protective ventilation (PV) in nonselected DBD upon lung procurement and recipient survival. Methods All reported DBD aged 18-70 years without lung recovery contraindication and with at least one organ recovered between January 2016 and December 2017 were included. Donor characteristics and management were collected at several times until decision on lung offer to transplant teams (t2). PV was defined as tidal volume ≤8 ml/kg of predicted body weight and PEEP≥ 8 cm H2O. The association between PV and lung procurement was determined with multivariable logistic regression stratified by propensity score quintile to account for PV and non PV group differences in baseline characteristics. Survival rates were estimated using Kaplan-Meier method and compared using log-rank test. Results Of the 1,626 included lung donors, 1,109 (68%) had at least one lung offered among whom 678 (61%) had at least one lung recovered. Among donors with lung offered, factors associated with reduced lung procurement were female gender (OR:0.63; 95%CI: 0.43-0.92, p=0.02), age (OR:0.97; 95%CI: 0.96-0.98, p 3 days (OR:0.51 95%CI: 0.38-0.69, p Conclusion The use of lung protective ventilation in nonselected DBD increased probability of lung procurement by 43%. Intermediate analysis suggests that 1-year survival did not differ between recipients of lungs from donors with or without PV.