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. 2024 Jul 24:6:100132.
doi: 10.1016/j.jhlto.2024.100132. eCollection 2024 Nov.

A multicenter analysis of lung transplantation outcomes comparing donation after circulatory death and donation after brain death

Mohammed Abul Kashem  1 , Gabriel Loor  2 , Matthew Hartwig  3 , Dirk Van Raemdonck  4 , Mauricio Villavicencio  5 , Fabio Ius  6 , Kamrouz Ghadimi  7 , Jawad Salman  6 , Satish Chandrashekaran  8 , Tiago Machuca  9 , Pablo G Sanchez  10 , Kathirvel Subramaniam  10 , Arne Neyrinck  4 , Hannah Calvelli  1 , Michael Warnick  1 , Huaqing Zhao  1 , Stephen Huddleston  11 , Asishana Osho  12 , Ethan D'Silva  2 , Uma Ramamurthy  2 , Andres Leon Pena  2 , Marcelo Salan-Gomez  2 , Andrew Shaffer  11 , Nathaniel Langer  12 , Amir Emtiazjoo  13 , Yoshiya Toyoda  1
Affiliations

A multicenter analysis of lung transplantation outcomes comparing donation after circulatory death and donation after brain death

Mohammed Abul Kashem et al. JHLT Open. .

Abstract

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.

Keywords: donation after brain death; donation after circulatory death; lung transplant; outcomes; survival.

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Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Fabio Ius reports a relationship with Biotest AG that includes consulting or advisory and funding grants. Gabriel Loor reports a relationship with TransMedics Inc. that includes consulting or advisory and funding grants. Gabriel Loor reports a relationship with AbioMed Inc. that includes consulting or advisory and funding grants. Gabriel Loor reports a relationship with AtriCure Inc. that includes funding grants. Gabriel Loor reports a relationship with JLH foundation that includes funding grants. Gabriel Loor reports a relationship with the American Association for Thoracic Surgery that includes funding grants. Gabriel Loor reports a relationship with Baylor College of Medicine that includes funding grants. Matthew Hartwig reports a relationship with CSL Behring that includes consulting or advisory. Matthew Hartwig reports a relationship with Intuitive Surgical Inc. that includes consulting or advisory. Matthew Hartwig reports a relationship with Biomed Innovations that includes funding grants. Gabriel Loor reports a relationship with Noon Endowment that includes funding grants. Matthew Hartwig reports a relationship with Paragonix Technologies, Inc. that includes funding grants. Matthew Hartwig reports a relationship with TransMedics Inc. that includes funding grants. Matthew Hartwig reports a relationship with Lung Bioengineering that includes funding grants. Arne Neyrinck reports a relationship with XVIVO that includes speaking and lecture fees. Yoshiya Toyoda reports a relationship with TransMedics Inc. that includes funding grants. Yoshiya Toyoda reports a relationship with Cerus Corporation that includes funding grants. Yoshiya Toyoda reports a relationship with EvaHeart Inc. that includes funding grants. Dirk Van Raemdonck is the Editor-in-Chief for JHLT Open. The other authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Acknowledgments: None. Meeting Presentation: This manuscript is the result of an abstract presented at the International Society of Heart and Lung Transplantation 43rd Annual Meeting from April 19-21 in Denver, Colorado, and was recommended for transfer to JHLT Open from the Journal of Heart and Lung Transplantation.

Figures

Figure 1
Figure 1
Multi-Institutional ECLS Registry study design. DBD, donation after brain death; DCD, donation after circulatory death; ECLS, extracorporeal life support; EVLP, ex vivo lung perfusion.
Figure 2
Figure 2
Kaplan-Meier 90-day survival curves for recipients of DCD and DBD lung transplantation before (A) and after propensity score matching (B). DCD recipients had significantly lower 90-day survival compared to DBD recipients before (p = 0.0066) and after propensity matching (p = 0.038). DBD, donation after brain death; DCD, donation after circulatory death.
Figure 3
Figure 3
Kaplan-Meier 90-day survival curves for recipients of intraoperative ECLS (A) and EVLP (B). There was significantly lower 90-day survival with ECLS compared to without ECLS (p = 0.014). There was no significant difference in 90-day survival based on utilization of EVLP (p = 0.47). ECLS, extracorporeal life support; EVLP, ex vivo lung perfusion.
Figure 4
Figure 4
Kaplan-Meier 90-day survival curves for recipients of DCD and DBD lung transplantation with and without utilization of intraoperative ECLS before (A) and after propensity score matching (B). DCD and DBD recipients had significantly lower 90-day survival with ECLS compared to without ECLS before (p = 0.0046) and after propensity matching (p = 0.039). DBD, donation after brain death; DCD, donation after circulatory death; ECLS, extracorporeal life support.
Figure 5
Figure 5
Kaplan-Meier 90-day survival curves for DCD (A) and DBD (B) transplantation with and without EVLP utilization. There was no significant difference in 90-day survival with EVLP compared to without EVLP for DCD (p = 0.5) and DBD recipients (p = 0.79). DBD, donation after brain death; DCD, donation after circulatory death; EVLP, ex vivo lung perfusion.
Figure 6
Figure 6
Kaplan-Meier 90-day survival curves for patients with PGD grade 3 and PGD grades 0 to 2 at t0h before (A) and after propensity score matching (B). PGD grade 3 was associated with significantly lower 90-day survival compared to PGD grades 0 to 2 before (p = 0.0084) but not after propensity matching (p = 0.17). PGD, primary graft dysfunction.
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