| Description |
- Introduction: Efforts to expand the lung transplant (LTx) donor pool have led to increased use of lungs from donors after circulatory death (DCD), with evidence demonstrating outcomes comparable to those from donors after brain death (DBD). Although increasing utilization of DCD lungs would augment the donor pool by an estimated 50%, their use remains below 5% in the U.S. Understanding donor factors associated with successful LTx following DCD is important in optimizing donor management. In this study, we examined critical care and ventilatory factors associated with DCD LTx and allograft survival using a novel granular donor management database.
Methods: The Donor Management Goals national registry was queried for DCD donors between January 2016 and July 2023. The primary outcomes were DCD lung utilization and allograft survival. Multivariable logistic regression and cox proportional hazards modeling was used to assess factors associated with DCD LTx and allograft survival, respectively.
Results: A total of 3,394 donors met inclusion criteria. Transplantation occurred in 202 (6.0%) cases with an 85.6% 1-year survival. DCD LTx was more likely to occur following cerebrovascular accidents compared to anoxia (OR 2.72 [1.76, 4.20], p<0.001) and from donors who achieved for a targeted PF ratio at the time of organ allocation (OR 2.90 [1.83, 4.63], p<0.001). Factors associated with decreased likelihood of LTx included increasing age (OR 0.87 [0.79, 0.95] per 5 year change when ≤ 50 years old, 0.51 [0.35, 0.69] per 5 year change when > 50 years old, p<0.001), increased donor INR (OR 0.86 [0.10, 0.55] per 0.1 unit change, p<0.001), donor height greater than 168 cm (OR 0.86 [0.79, 0.95] per 3 cm increase, p=0.003), increased hematocrit (OR 0.95 [0.92, 0.98] p=0.002), and increased PEEP at the time of organ allocation (OR 0.90 [0.83, 0.97], p=0.01). Donor treatment with steroids (HR 3.14 [1.15, 8.54], p=0.025), and controlled mechanical ventilation mode (HR 2.35 (1.14, 4.85), p=0.019), were associated with an increased likelihood of graft failure at one year.
Discussion: Successful DCD LTx associates with potentially modifiable donor parameters, including targeted P/F ratio, PEEP, INR, and hematocrit. Additionally, careful consideration of steroid use and ventilator settings may be important for improving long-term graft function. These modifiable factors may inform strategies to increase DCD LTx and improve survival.
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