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Expanding the horizons: Uncontrolled donors after circulatory death for lung transplantation—First comparison with brain death donors
Author(s) -
Valdivia Daniel,
Gómez de Antonio David,
Hoyos Lucas,
CampoCañaveral de la Cruz Jose Luis,
Romero Alejandra,
Varela de Ugarte Andrés
Publication year - 2019
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.13561
Subject(s) - medicine , circulatory system , lung transplantation , transplantation , lung , intensive care medicine , surgery
Uncontrolled donation after cardiac death is an appealing source of organs for lung transplantation. We compare early and long‐term outcomes of lung transplantation with these donors with a cohort of transplants from brain death donors at our institution. Retrospective analysis of all lung transplantations was performed from 2002 to 2012. We collected variables regarding recipients, donors, recover and transplant procedures, early and late complications, and survival. We included 292 lung transplants from brain death donors and 38 from uncontrolled donors after cardiac death. Both groups were comparable except for sex mismatch (male recipient‐female donor was more frequent in the brain death cohort, 17.8% vs 0%, P 0.002), total ischemic time (longer for donors after cardiac death, 657 minutes for the first lung and 822 minutes for the second vs 309 and 425 minutes, P < 0.001), and ex vivo evaluation (more frequent in cardiac death donors, 21.1% vs 1.4%, P < 0.001). Early and late outcomes were not different (ICU stay [9 vs 10.5 days], hospital stay [33.5 vs 35 days], primary graft dysfunction G3 [24 vs 34.2%], and chronic graft dysfunction HR 1.19 [0.61‐2.32]), but overall survival was significantly lower for patients transplanted from cardiac death donors [HR 1.67 (1.06‐2.64)]. Lung transplantation after uncontrolled cardiac death offers poorer results in terms of survival compared to brain death donation. Refinement of current strategies for graft preservation and evaluation is essential to improve outcomes with this source of grafts.