Short and long-term outcomes of lung transplantation from brain death vs. circulatory death donors: A meta-analysis of comparative studies

Abstract

Background: To investigate through a meta-analysis of comparative studies the impact of donor type (brain death DBD vs circulatory death DCD) on the short- and long-term outcomes of lung transplantation(LTx).

Methods: Literature search (terms "lung transplantation" AND "donation after circulatory death") was performed up to July 2022 and studies comparing outcomes of LTx from DCD versus DBD were selected. Primary endpoints were early and long-term mortality. Secondary outcomes included primary graft dysfunction (PGD),acute rejection and postoperative complications. The long-term survival was analyzed by retrieving data from each available Kaplan-Meier and restricted mean survival time difference between DBD and DCD for long-term survival was estimated.

Results: 21 studies were included comprising 60105 patients (DBD=58548 DCD=1557). Recipient and donor baseline characteristics were similar between the two groups. No significant publication bias was observed. The estimated pooled odds ratio of early mortality favored DBD (OR=0.75,CI=0.56-1.00, I²=0%). No statistically significant difference was observed in the risk of acute rejection (OR=1.33, CI=0.82-2.17), and PGD grade 2-3 (OR=0.88, CI=0.69-1.13). One- and 5-year survival were 82.1% and 51.2%, and 86.2% and 62.7% for DBD and DCD groups, respectively (Log-rank,p<0.0001). Unadjusted hazard ratio was 0.693, with DCD as reference. DCD lungs demonstrated improved survival by 4.82% over 5-years when compared to DBD lungs.

Conclusions: This meta-analysis of comparative studies between DCD and DBD demonstrates significant long-term survival advantage of DCD LTx despite an initial small but statistically significant increased mortality risk in the short-term. Data supports the continued implementation of DCD to increase the lung donor pool.

Keywords: Acute rejection; Donation after Brain Death; Donation after Circulatory Death; Lung Transplantation.