Favorable Outcomes of Donation after Cardiac Death in Lung Transplantation: A Multicenter Study

Abstract

Purpose The ISHLT recently established a donation after cardiac death (DCD) registry which captures detailed data in DCD lung transplantation (LTx), an approach that has a potential to greatly increase LTx volumes. Our aim was to examine outcomes after DCD LTx. Methods and Materials We analyzed data in the ISHLT DCD registry collected from 9 centers in North America, Europe and Australia. Primary endpoint was 1-year post-transplant survival in LTx using DCD vs. brain death donors (DBD). Results Between January 2003 and August 2012, 224 transplants were performed in the DCD cohort and 2744 transplants in the DBD cohort at the participating institutions. There was a marked increase in DCD LTx from 2003 to 2012. 95.5% of the DCD LTx were Maastricht category III, 2.7% category IV and 1.8% category V (euthanasia). Heparin was given in 48% of the DCD cases, donor extubation occurred in 87%, and EVLP was used in 13% of the cases. The median time from WLST to cardiac arrest was 15min (5-46min), and from WLST to cold flush 32min (20-77min). Recipient age and medical diagnosis were similar in DCD and DBD groups (p=NS). Median hospital length of stay was 18d in DCD and 16d in BDD groups (p=0.002). Thirty-day survival was 97% in both groups, 1-year survival was 88% in BDD and 89% in DCD (p=NS). The mechanism of donor death in the DCD group seemed to influence early recipient survival. All 30-day deaths were in transplants from donors with head trauma (p=0.002). Survival rates at 1-year were 95% for anoxic injury, 90% for cerebrovascular events, and 85% for head trauma (p=0.10). There was no significant correlation between the interval of WLST to pulmonary flush with survival (p=NS). Conclusions In this largest series of DCD LTx to date we show that early and intermediate outcomes are equivalent to the traditional DBD LTx. While DBD LTx volumes have remained stable during the study period, there was a marked increase in the number of DCD LTx. Our study suggests that efforts should be continued to further promote DCD LTx.