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. 2023 Feb 8:36:10690.
doi: 10.3389/ti.2023.10690. eCollection 2023.

Lung Transplantation From Controlled and Uncontrolled Donation After Circulatory Death (DCD) Donors With Long Ischemic Times Managed by Simple Normothermic Ventilation and Ex-Vivo Lung Perfusion Assessment

Alessandro Palleschi  1   2 , Alberto Zanella  1   3 , Giuseppe Citerio  4   5 , Valeria Musso  1   2 , Lorenzo Rosso  1   2 , Davide Tosi  2 , Jacopo Fumagalli  3 , Gianluca Bonitta  1 , Elena Benazzi  6 , Gianluca Lopez  7 , Valeria Rossetti  8 , Letizia Corinna Morlacchi  8 , Clarissa Uslenghi  1   2 , Massimo Cardillo  9 , Francesco Blasi  1   8 , Giacomo Grasselli  1   3 , Franco Valenza  1   10 , Mario Nosotti  1   2
Affiliations

Lung Transplantation From Controlled and Uncontrolled Donation After Circulatory Death (DCD) Donors With Long Ischemic Times Managed by Simple Normothermic Ventilation and Ex-Vivo Lung Perfusion Assessment

Alessandro Palleschi et al. Transpl Int. .

Abstract

Donation after cardiac death (DCD) donors are still subject of studies. In this prospective cohort trial, we compared outcomes after lung transplantation (LT) of subjects receiving lungs from DCD donors with those of subjects receiving lungs from donation after brain death (DBD) donors (ClinicalTrial.gov: NCT02061462). Lungs from DCD donors were preserved in-vivo through normothermic ventilation, as per our protocol. We enrolled candidates for bilateral LT ≥14 years. Candidates for multi-organ or re-LT, donors aged ≥65 years, DCD category I or IV donors were excluded. We recorded clinical data on donors and recipients. Primary endpoint was 30-day mortality. Secondary endpoints were: duration of mechanical ventilation (MV), intensive care unit (ICU) length of stay, severe primary graft dysfunction (PGD3) and chronic lung allograft dysfunction (CLAD). 121 patients (110 DBD Group, 11 DCD Group) were enrolled. 30-day mortality and CLAD prevalence were nil in the DCD Group. DCD Group patients required longer MV (DCD Group: 2 days, DBD Group: 1 day, p = 0.011). ICU length of stay and PGD3 rate were higher in DCD Group but did not significantly differ. LT with DCD grafts procured with our protocols appears safe, despite prolonged ischemia times.

Keywords: chronic lung allograft dysfunction; donation after circulatory death donors; ischemia time; lung preservation; lung transplantation; primary graft dysfunction.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Study population flow-chart. LT: lung transplantation; ReLT: retransplantation.
FIGURE 2
FIGURE 2
Overall flow-chart of our DCD program.
FIGURE 3
FIGURE 3
Kaplan-Meier curves illustrating CLAD-free survival in the DCD and DBD Group.
FIGURE 4
FIGURE 4
Kaplan-Meier curves illustrating overall survival in the DCD and DBD Group.
FIGURE 5
FIGURE 5
Mean FEV1 (%) at 3, 6, and 12 months after transplantation.
FIGURE 6
FIGURE 6
Mean FVC (%) at 3, 6, and 12 months after transplantation.
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