The Comparable Efficacy of Lung Donation After Circulatory Death and Brain Death: A Systematic Review and Meta-analysis

Abstract

Background. Lung transplantations (LTx) have become an effective lifesaving treatment for patients with end-stage lung diseases. While the shortage of lung donor pool and severe posttransplantation complications exaggerate the obstacle of LTx. This meta-analysis aimed to evaluate the efficacy of donation after circulatory death (DCD) in LTx for patients with endstage lung diseases. Methods. PubMed, EmBase, and Web of Science were systematically searched for all relevant studies comparing the efficacy of DCD and conventional donation after brain death (DBD). The relative risk (RR) value as well as the weighted mean difference with a 95% confidence interval (CI) were pooled for dichotomous and continuous outcomes, respectively. The heterogeneity across the included studies was also assessed carefully. Results. Overall, 17 studies with 995 DCD recipients and 38 579 DBD recipients were included. The pooled analysis showed comparable 1-year overall survival between the 2 cohorts (RR 0.89, 95% CI, 0.74-1.07, P = 0.536, I 2 = 0%). The airway anastomotic complications rate in DCD cohort was higher than that in DBD cohorts (RR 2.00; 95% CI, 1.29-3.11, P = 0.002, I 2 = 0%). There was no significant difference between DCD and DBD regarding the occurrence of primary graft dysfunction grade 2/3, bronchiolitis obliterans syndrome, acute transplantation rejection, and length of stay. The stability of the included studies was strong. Conclusions. Evidence of this meta-analysis indicated that the use of lungs from DCD donors could effectively and safely expand the donor pool and therefore alleviate the crisis of organ shortage.

Lung transplantation from controlled donation after circulatory death using simultaneous abdominal normothermic regional perfusion: A single center experience

“…Acute cellular rejection remains a significant risk factor for CLAD and can affect long‐term survival after LT. The rate of acute rejection was identical in both groups and similar to most previous studies 30 . Pre‐transplant prevalence of anti‐HLA antibodies and the prevalence of DSA´s during follow‐up were identical in both groups.…”

Trends in Donation After Circulatory Death in Lung Transplantation in the United States: Impact Of Era

“…Two additional meta-analyses found no difference in 1-year survival between DBD and DCD lungs. ( 4 , 15 ) In a database analysis of the International Society for Heart and Lung Transplantation (ISHLT) registry using unadjusted and multivariable analyses, there was no difference in 5-year survival between DBD and DCD organs, though a survival benefit was associated with era of transplant (2003–2009 vs. 2010–2016) ( 16 ). Similarly our analysis using 15 years of data and over 27,000 lung transplant cases in the United States, did not demonstrate a survival difference between DBD and DCD lungs, but found a survival benefit associated with more recent era of transplant.…”

An Intention-to-treat View of Lung Transplantation for Interstitial Lung Disease: Successful Strategies to Minimize Waiting List and Posttransplant Mortality

“…8 Median mechanical ventilation time (30 h), intensive care unit stay (4.5 d), and rates of grade 2/3 PGD (26%) were comparable to other studies. 34,35 Indeed, there is now mounting evidence that the utilization of extended-criteria 16,33 and DCD donor lungs 14,15,26,36 does not jeopardize posttransplant outcomes, and data from this study now provide further evidence in support of these notions in the ILD lung transplant patient population.…”