A multicenter analysis of lung transplantation outcomes comparing donation after circulatory death and donation after brain death
Mohammed Abul Kashem, MD, PhD,
Gabriel Loor, MD,
Matthew Hartwig, MD,
Dirk Van Raemdonck, MD, PhD,
Mauricio Villavicencio, MD,
Fabio Ius, MD,
Kamrouz Ghadimi, MD,
Jawad Salman, MD,
Satish Chandrashekaran, MD,
Tiago Machuca, MD, PhD,
Pablo G. Sanchez, MD, PhD,
Kathirvel Subramaniam, MD,
Arne Neyrinck, MD, PhD,
Hannah Calvelli, BA,
Michael Warnick, BS,
Huaqing Zhao, PhD,
Stephen Huddleston, MD, PhD,
Asishana Osho, MD,
Ethan D'Silva, MD,
Uma Ramamurthy, PhD,
Andres Leon Pena, MD,
Marcelo Salan-Gomez, MD,
Andrew Shaffer, MD,
Nathaniel Langer, MD,
Amir Emtiazjoo, MD,
Yoshiya Toyoda, MD, PhD
Affiliations
Mohammed Abul Kashem, MD, PhD
Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania; Corresponding author: Mohammed Abul Kashem, MD, PhD, Lewis Katz School of Medicine at Temple University, 3500 N Broad St, Philadelphia, PA 19140.
Gabriel Loor, MD
Baylor College of Medicine, Houston, Texas
Matthew Hartwig, MD
Duke University Medical Center, Durham, North Carolina
Dirk Van Raemdonck, MD, PhD
University Hospitals Leuven, Leuven, Belgium
Mauricio Villavicencio, MD
Mayo Clinic, Rochester, Minnesota
Fabio Ius, MD
Hannover Medical School, Hannover, Germany
Kamrouz Ghadimi, MD
Duke University, Durham, North Carolina
Jawad Salman, MD
Hannover Medical School, Hannover, Germany
Satish Chandrashekaran, MD
Emory University Hospital, Atlanta, Georgia
Tiago Machuca, MD, PhD
University of Miami School of Medicine, Miami, Florida
Pablo G. Sanchez, MD, PhD
University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
Kathirvel Subramaniam, MD
University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
Arne Neyrinck, MD, PhD
University Hospitals Leuven, Leuven, Belgium
Hannah Calvelli, BA
Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
Michael Warnick, BS
Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
Huaqing Zhao, PhD
Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
Stephen Huddleston, MD, PhD
University of Minnesota, Minneapolis, Minnesota
Asishana Osho, MD
Massachusetts General Hospital, Boston, Massachusetts
Ethan D'Silva, MD
Baylor College of Medicine, Houston, Texas
Uma Ramamurthy, PhD
Baylor College of Medicine, Houston, Texas
Andres Leon Pena, MD
Baylor College of Medicine, Houston, Texas
Marcelo Salan-Gomez, MD
Baylor College of Medicine, Houston, Texas
Andrew Shaffer, MD
University of Minnesota, Minneapolis, Minnesota
Nathaniel Langer, MD
Massachusetts General Hospital, Boston, Massachusetts
Amir Emtiazjoo, MD
University of Florida, Gainesville, Florida
Yoshiya Toyoda, MD, PhD
Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
Background: Donor organ shortage is a barrier to lung transplantation. Donation after circulatory death (DCD) may offer a solution, although it is underutilized. The objective of this study was to compare survival and other postoperative outcomes between DCD and donation after brain death (DBD). Methods: We performed a multicenter analysis of Multi-Institutional Extracorporeal Life Support (ECLS) Registry data from 11 lung transplant centers in the United States and Europe. Demographics and clinical parameters were compared using chi-square test and Fisher's exact test. Survival was assessed by Kaplan-Meier curves and compared by log-rank test with propensity score matching. Results: Of 1,585 patients included in the study, 135 (8.5%) received DCD lungs and 1,450 (91.5%) received DBD lungs. DCD recipients had higher rates of obstructive lung disease (p = 0.042), longer total ischemic time (p < 0.0001), and higher rates of primary graft dysfunction (PGD) at t0h (p < 0.0001) and t24h (p = 0.0005). PGD at t48h and t72h was not significantly different between DCD and DBD recipients. Ninety-day survival was lower among DCD recipients (91.2%) compared to DBD recipients (97.4%, p = 0.038). Survival was higher without ECLS (p = 0.014), whereas ex vivo lung perfusion (EVLP) (p = 0.47) did not affect survival. Conclusions: Overall, our data showed excellent 90-day survival for DCD and DBD recipients, although DCD recipients had relatively lower survival. EVLP was not associated with survival, which may guide future strategies to optimize DCD utilization.
