Background

This study aimed to examine intermediate-term outcomes of lung transplantation (LTx) recipients from donors after circulatory death (DCD).

Methods

We examined the International Society for Heart and Lung Transplantation (ISHLT) Thoracic Transplant Registry data for patients transplanted between January 2003 and June 2017 at 22 centers in North America, Europe, and Australia participating in the DCD Registry. The distribution of continuous variables was summarized as median and interquartile range (IQR) values. Wilcoxon rank sum test was used to compare distribution of continuous variables and chi-square or Fisher's exact test for categorical variables. Kaplan-Meier survival rates after LTx from January 2003 to June 2016 were compared between DCD-III (Maastricht category III withdrawal of life-sustaining therapy [WLST]) only and donors after brain death (DBD) using the log-rank test. Risk factors for 5-year mortality were investigated using Cox multivariate proportional-hazards model.

Results

The study cohort included 11,516 lung transplants, of which 1,090 (9.5%) were DCD lung transplants with complete data. DCD-III comprised 94.1% of the DCD cohort. Among the participating centers, the proportion of DCD-LTx performed each year increased from 0.6% in 2003 to 13.5% in 2016. DCD donor management included extubation in 91%, intravenous heparin in 53% and pre-transplant normothermic ex vivo donor lung perfusion in 15%. The median time interval from WLST to cardiac arrest was 15 minutes (IQR: 11-22 minutes) and to cold flush 32 minutes (IQR: 26-41minutes). Compared with DBD, donor age was higher in DCD-III donors (46 years [IQR: 34-55] vs 40 years [IQR: 24-52]), bilateral LTx was performed more often (88.3% vs 76.6%), and more recipients had chronic obstructive pulmonary disease and emphysema as their transplant indication. Five-year survival rates were comparable (63% vs 61%, p = 0.72). In multivariable analysis, recipient and donor ages, indication diagnosis, procedure type (single vs bilateral and double LTx), and transplant era (2003-2009 vs 2010-2016) were independently associated with survival (p < 0.001), but donor type was not (DCD-III vs DBD; hazard ratio, 1.04 [0.90-1.19], p = 0.61).

Conclusion

This ISHLT DCD Registry report with 5-year follow-up demonstrated similar favorable long-term survival in DCD-III and DBD lung donor recipients at 22 experienced centers globally. These data indicate that more extensive use of DCD-LTx would increase donor organ availability and may reduce waiting list mortality.

中文翻译：

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ISHLT Registry对肺移植进行循环死亡后的五年随访中的捐赠。

背景

这项研究旨在检查循环死亡（DCD）后来自供体的肺移植（LTx）接受者的中期结局。

方法

我们检查了国际心脏和肺移植协会（ISHLT）胸腔移植注册系统的数据，该数据针对2003年1月至2017年6月之间在北美，欧洲和澳大利亚的22个参与DCD注册系统的中心移植的患者。连续变量的分布概括为中位数和四分位间距（IQR）值。使用Wilcoxon秩和检验比较连续变量的分布和分类变量的卡方检验或Fisher精确检验。使用对数秩检验，比较了仅DCD-III（马斯特里赫特III类维持生命疗法[WLST]的撤消）和脑死亡后的捐献者（DBD）在2003年1月至2016年6月LTx术后Kaplan-Meier生存率。使用Cox多元比例风险模型调查了5年死亡率的风险因素。

结果

该研究队列包括11,516例肺移植，其中1,090例（9.5％）是具有完整数据的DCD肺移植。DCD-III占DCD队列的94.1％。在参与中心中，每年执行的DCD-LTx比例从2003年的0.6％增加到2016年的13.5％。DCD捐助者管理包括拔管91％，静脉肝素53％和移植前体温正常的离体捐助者肺灌注在15％。从WLST到心脏骤停的中位时间间隔为15分钟（IQR：11-22分钟），至冷冲洗时间为32分钟（IQR：26-41分钟）。与DBD相比，DCD-III供体的供体年龄更高（46岁[IQR：34-55]比40岁[IQR：24-52]），双侧LTx的执行频率更高（88.3％vs 76.6％），并且越来越多的接受者以慢性阻塞性肺疾病和肺气肿为移植指征。p  = 0.72）。在多变量分析中，受者和供体的年龄，适应症诊断，手术类型（单侧，双侧和双侧LTx）和移植时代（2003-2009年与2010-2016年）与生存率独立相关（p <0.001），但供体类型为否（DCD-III与DBD；危险比，1.04 [0.90-1.19]，p  = 0.61）。

结论

这份ISHLT DCD注册机构的5年随访报告显示，全球22个经验丰富的中心在DCD-III和DBD肺供体接受者中具有相似的长期有利生存。这些数据表明，更广泛地使用DCD-LTx会增加供体器官的利用率，并可能降低候补名单的死亡率。