Lung Transplantation With Donation After Circulatory Determination of Death Donors and the Impact of Ex Vivo Lung Perfusion

Abstract

The growing demand for suitable lungs for transplantation drives the quest for alternative strategies to expand the donor pool. The aim of this study is to evaluate the outcomes of lung transplantation (LTx) with donation after circulatory determination of death (DCDD) and the impact of selective ex vivo lung perfusion (EVLP). From 2007 to 2013, 673 LTx were performed, with 62 (9.2%) of them using DCDDs (seven bridged cases). Cases bridged with mechanical ventilation/extracorporeal life support were excluded. From 55 DCDDs, 28 (51%) underwent EVLP. Outcomes for LTx using DCDDs and donation after neurological determination of death (DNDD) donors were similar, with 1 and 5-year survivals of 85% and 54% vs 86% and 62%, respectively (p ¼ 0.43). Although comparison of survival curves between DCDD þ EVLP vs DCDD-no EVLP showed no significant difference, DCDD þ EVLP cases presented shorter hospital stay (median 18 vs. 23 days, p ¼ 0.047) and a trend toward shorter length of mechanical ventilation (2 vs. 3 days, p ¼ 0.059). DCDDs represent a valuable source of lungs for transplantation, providing similar results to DNDDs. EVLP seems an important technique in the armamentarium to safely increase lung utilization from DCDDs; however, further studies are necessary to better define the role of EVLP in this context.

A Multicenter Study on Long-Term Outcomes After Lung Transplantation Comparing Donation After Circulatory Death and Donation After Brain Death

“…This low number of EVLP use is in contrast to the numbers of the Toronto group. In their protocol, a substantial number of DCD3 lungs is considered an indication for the use of EVLP (14,15). In our protocol we waited a maximum of 90 min for circulatory arrest to occur after withdrawal of the treatment.…”

Extracorporeal membrane oxygenation in the pre and post lung transplant period

“…Outcomes of DCD lung have been shown to be similar to conventionally harvested organs (95)(96)(97). Sometimes EVLP support is utilized after DCD organ harvesting and may result in improved outcomes (98). The overall long-term impact of EVLP and DCD organ donation in lung transplantation is not fully understood, and further research is needed to establish a clear role for these technologies in organ transplantation.…”

Effect of organ donation after circulatory determination of death on number of organ transplants from donors with neurologic determination of death

“…Initially reported for kidney recipients, successful transplants from DCD donors have now been performed with lung, liver and, most recently, heart. [6][7][8][9][10] In the setting of this advance in organ donation, concerns have been raised about the quality and yield of organs from DCD and about whether an active DCD program replaces organs that would otherwise have been procured through NDD donation.…”