Long-term results after lung transplantation using organs from circulatory death donors: a propensity score-matched analysis†.

Abstract

OBJECTIVES:

Due to organ shortage in lung transplantation (LTx), donation after circulatory death (DCD) has been implemented in several countries, contributing to an increasing number of organs transplanted. We sought to assess long-term outcomes after LTx with organs procured following circulatory death in comparison with those obtained from donors after brain death (DBD).

METHODS:

Between January 2007 and November 2013, 302 LTxs were performed in our institution, whereby 60 (19.9%) organs were retrieved from DCD donors. We performed propensity score matching (DCD:DBD = 1:2) based on preoperative donor and recipient factors that were significantly different in univariate analysis.

RESULTS:

After propensity matching, there were no statistically significant differences between the groups in terms of demographics and preoperative donor and recipient characteristics. There were no significant differences regarding intraoperative variables and total ischaemic time. Patients from the DCD group had significantly higher incidence of primary graft dysfunction grade 3 at the end of the procedure (P = 0.014), and significantly lower pO2/FiO2 ratio during the first 24 h after the procedure (P = 0.018). There was a trend towards higher incidence of the need for postoperative extracorporeal life support in the DCD group. Other postoperative characteristics were comparable. While the overall cumulative survival was not significantly different, the DCD group had significantly poorer results in terms of bronchiolitis obliterans syndrome (BOS)-free survival in the long-term follow-up.

CONCLUSIONS:

Long-term results after LTx with organs procured following DCD are in general comparable with those obtained after DBD LTx. However, patients transplanted using organs from DCD donors have a predisposition for development of BOS in the longer follow-up.

• Authors: Anton Sabashnikov, Nikhil P Patil, Aron-Frederik Popov, Simona Soresi, Bartlomiej Zych, Alexander Weymann, Prashant N Mohite, Diana García Sáez, Mohamed Zeriouh, Thorsten Wahlers, Yeong-Hoon Choi, Jens Wippermann, Thorsten Wittwer, Fabio De Robertis, Toufan Bahrami, Mohamed Amrani, André R Simon
• Journal: European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery (Eur J Cardiothorac Surg) Vol. 49 Issue 1 Pg. 46-53 (Jan 2016) ISSN: 1873-734X [Electronic] Germany
• PMID: 25777057 (Publication Type: Comparative Study, Journal Article)
• Copyright: © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Topics

• Adult
• Cause of Death
• Cohort Studies
• Death
• Female
• Follow-Up Studies
• Graft Rejection
• Graft Survival
• Heart Failure (mortality)
• Humans
• Italy
• Kaplan-Meier Estimate
• Lung Transplantation (methods, mortality)
• Male
• Middle Aged
• Organ Preservation (methods)
• Propensity Score
• Proportional Hazards Models
• Retrospective Studies
• Risk Assessment
• Time Factors
• Tissue Donors (supply & distribution)
• Tissue and Organ Procurement