Time from Start of Agonal Phase to Pulmonary Artery Cross Clamp in Donor Cardiac Death Donors Does Not Correlate with Diminished Recipient Lung Function or Survival

Abstract

Purpose Donor cardiac death (DCD) donors could expand the field of lung donors, but the acceptably safe time interval between the onset of agonal phase and application of the pulmonary artery clamp is controversial. The purpose of this study was to determine if the time from the beginning of the agonal phase to placement of the pulmonary artery cross clamp in DCD donors is associated with worse recipient lung function or long-term survival. Methods The Scientific Registry for Transplant Research database (2008-2019) was queried for lung transplants performed from DCD donors (N=227) excluding pediatric, multi-organ, and redo lung transplants. Time from the beginning of agonal phase to the time of pulmonary artery cross clamp placement was determined, and donor and recipient characteristics and outcomes were examined for 3 groups: 0-30 minutes (N=178), 30-45 minutes (N=25), and over 45 minutes (N=21). Eight DCD donor lungs had an agonal phase to pulmonary artery cross clamp time between 75 and 120 minutes. The primary endpoints were forced expiratory volume in 1 second (FEV1) at 1 and 2 years and overall survival using Kaplan Meier analysis. Results There were no significant differences in donor age, gender or body mass index between the three groups. Recipient characteristics were comparable between the three groups, and there was no difference in recipient FEV1 at 1 (80.47+/-22.45%, 79.81+/-16.60%, and 76.67+/-13.30%, p=0.840) and 2 years (76.23+/-27.13%, 76.11+/-24.31%, 82.17+/-17.58%, p=0.868) for the three groups (0-30 minutes, 30-45 minutes, and over 45 minutes, respectively) . There was no difference in long term survival out to 10 years between the three groups using Kaplan Meier analysis. Conclusion Lung transplant recipient lung function and survival is similar for recipients of DCD donor lungs regardless of the time from start of the agonal phase to application of the pulmonary artery transplant out to and beyond 45 minutes.