Lung Donation After Controlled Circulatory Determination of Death: A Review of Current Practices and Outcomes

Sanchez, P.G.; Rouse, Michael W.; Pratt, DL; Kon, ZN; Pierson, R. N.; Rajagopal, Keshava; At, Iacono; Pham, S.M.; Griffith, B.

doi:10.1016/j.transproceed.2015.06.026

Cited by 5 publications

(1 citation statement)

References 33 publications

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“…The use of EVLP could be helpful to overcome this limitation. Despite these challenges, many recent studies have demonstrated DCD LTx results to be comparable to those obtained from DBD donation [5‐9,25,26]. Recently, we have reported a Kaplan–Meier analysis showing comparable cumulative survival in the DBD and DCD group of 84.2 vs. 86.1% at 1 year, 77.3 vs. 60.9% at 3 years, and 66.4 vs. 50.8% at 7 years, respectively [3,13].…”

Section: Discussionmentioning

confidence: 97%

Utilization of extracorporeal membrane oxygenation in DCD and DBD lung transplants: a 2‐year single‐center experience

Sef

Mohite

et al. 2020

Transpl. Int.

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Summary Donation after circulatory death (DCD) has the potential to expand the lung donor pool. We aimed to assess whether DCD affected the need for perioperative extracorporeal membrane oxygenation (ECMO) and perioperative outcomes in lung transplantation (LTx) as compared to donation after brain death (DBD). All consecutive LTxs performed between April 2017 and March 2019 at our tertiary center were analyzed. Donor and recipient preoperative characteristics, utilization of ECMO, and perioperative clinical outcomes were compared between DCD and DBD LTx. Multivariate models (frequentist and Bayes) were fitted to evaluate an independent effect of DCD on the intra‐ and postoperative need for ECMO. Out of 105 enrolled patients, 25 (23.8%) were DCD LTx. Donors’ and preoperative recipients’ characteristics were comparable between the groups. Intraoperatively, mechanical circulatory support (MCS) was more common in DCD LTx (56.0% vs. 36.2%), but the adjusted difference was minor (RR = 1.16, 95% CI 0.64–2.12; P = 0.613). MCS duration, and first and second lung ischemia time were longer in the DCD group. Postoperatively, DCD recipients more commonly required ECMO (32.0% vs. 7.5%) and the difference remained considerable after adjustment for the pre‐ and intraoperative covariates: RR = 4.11 (95% CI 0.95–17.7), P = 0.058, Bayes RR = 4.15 (95% CrI 1.28–13.0). Sensitivity analyses (two DCD‐DBD matching procedures) supported a higher risk of postoperative ECMO need in DCD patients. Incidence of delayed chest closure, postoperative chest drainage, and renal replacement therapy was higher in the DCD group. Early postoperative outcomes after DCD LTx appeared generally comparable to those after DBD LTx. DCD was associated with a higher need for postoperative ECMO which could influence clinical outcomes. However, as the DCD group had a significantly higher use of EVLP with more common ECMO preoperatively, this might have contributed to worse outcomes in the DCD group.

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Section: Discussionmentioning

confidence: 97%

Utilization of extracorporeal membrane oxygenation in DCD and DBD lung transplants: a 2‐year single‐center experience

Sef

Mohite

et al. 2020

Transpl. Int.

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Donation after circulatory death (DCD)—lung procurement

Keshavamurthy

Rodgers-Fischl

2021

Indian J Thorac Cardiovasc Surg

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The number of lungs available for lung transplantation is far lower than the number of patients awaiting them. Consequently, there is a significant attrition rate while awaiting transplantation. Lung procurement rates are lower than those of other solid organs. Lungs are procured from only 15–20% of donors compared with 30% of decreased donors for hearts. The reason for this low retrieval rate is related to a number of factors. Brain death is associated with neurogenic pulmonary edema. Additionally, injury to the lung itself may occur before or after brain death. Aspiration of gastric contents, pneumonia, previous thoracic trauma, ventilator-associated injury, atelectasis, and pulmonary thrombosis/embolism may all contribute to lung injury before consideration for harvest. Donation after circulatory death (DCD) is one category of nontraditional organ donation now being performed in increasing numbers as a way to increase the number of lungs available for transplantation. In some studies, estimates show that utilization of DCD lung procurement could increase the number of lungs available by up to 50%.

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Transesophageal Echocardiography in Noncardiac Thoracic Surgery

Sullivan¹,

Leiendecker²

2022

Cohen's Comprehensive Thoracic Anesthesia

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Lung Donation After Controlled Circulatory Determination of Death: A Review of Current Practices and Outcomes

Cited by 5 publications

References 33 publications

Utilization of extracorporeal membrane oxygenation in DCD and DBD lung transplants: a 2‐year single‐center experience

Utilization of extracorporeal membrane oxygenation in DCD and DBD lung transplants: a 2‐year single‐center experience

Donation after circulatory death (DCD)—lung procurement

Transesophageal Echocardiography in Noncardiac Thoracic Surgery

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