Reflections on Australian DCD lung donation and transplant journey Report from the 38th Annual Meeting — International Society for Heart and Lung Transplantation, Nice, France: 11–14 April 2018

Abstract

‘10 Years On: The Significant Impact of Controlled DCD Lung Donors on Lung Transplant Opportunities and Outcomes’ Purpose Since 2006, the Alfred Hospital has increasingly utilised controlled DCD donor lungs to optimise LTx opportunities and reduced waiting list (WL) deaths. This study evaluated the impact of DCD donation on LTx WL time and mortality, and compared post-LTx outcomes of DCD and contemporaneous DBD LTx performed over the first 10 years. Method This was a retrospective analysis of all LTx done at our institution between May 2006 and February 2017 (n=696, 150 DCD LTx, 546 DBD LTx) was undertaken. WL time/mortality, donor and recipient demographics, early outcome measures, survival and cause of death were compared. Our institution regularly utilises extended DCD and DBD donor lungs; however, it does not yet routinely utilise ex-vivo lung perfusion (EVLP) to evaluate these extended donor lungs, unlike many programs in the USA and Europe. Results The use of DCD donors has resulted in 25% more LTx annually, reduced overall WL times (245 to 135 days, p<0.001) and WL mortality (29% to 5%, p<0.01) from 2006 to 2017 respectively. Compared to DBD, DCD donors were intubated in ICU Longer (115 vs 79hrs, p<0.01), were older (45 vs 41 yrs, p<0.01) and were less commonly distant (>300 km) donors (20% vs 35%, p<0.01). DCD recipients compared to DBD had a reduced WL time (101 vs 120 days, p=0.03) and longer graft ischaemic time (323 vs 287 mins, p<0.01). There was no difference in intensive care unit (ICU) or hospital length of stay between DCD and DBD; and importantly, no significant difference in 1, 5 or 10 year survival rates comparing DCD vs DBD (96%, 69% and 53% vs 92%, 64% and 51% respectively, p=ns). Conclusions Controlled DCD donation has significantly and safely increased overall LTx numbers, without reducing DBD LTx (Figure 1), and has also reduced WL time and mortality with excellent 1, 5 and 10 year LTx survival for both DCD and DBD LTx compared to ISHLT at our institution (Figure 2). Importantly, our results also show that EVLP is not required for a successful utilisation of DCD donor lungs for LTx.