Cypel Marcelo, Sato Masaaki, Yildirim Erkan, Karolak Wojtek, Chen Fengshi, Yeung Jonathan, Boasquevisque Carlos, Leist Victoria, Singer Lianne G, Yasufuku Kazuhiro, Deperrot Marc, Waddell Thomas K, Keshavjee Shaf, Pierre Andrew
The Toronto Lung Transplant Program, University of Toronto, Toronto, Ontario, Canada.
J Heart Lung Transplant. 2009 Aug;28(8):753-8. doi: 10.1016/j.healun.2009.05.009. Epub 2009 Jun 28.
Organ donation after cardiac death (DCD) has the potential to alleviate some of the shortage of suitable lungs for transplantation. Only limited data describe outcomes after DCD lung transplantation. This study describes the early and intermediate outcomes after DCD lung transplantation in Canada.
Data were collected from donors and recipients involved in DCD lung transplantations between June 2006 and December 2008. Described are the lung DCD protocol, donor characteristics, and the occurrence of post-transplant events including primary graft dysfunction (PGD), bronchial complications, acute rejection (AR), bronchiolitis obliterans syndrome (BOS), and survival.
Successful multiorgan controlled DCD increased from 4 donors in 2006 to 26 in 2008. Utilization rates of lungs among DCD donors were 0% in 2006, 11% in 2007, and 27% in 2008. The lung transplant team evaluated 13 DCD donors on site, and lungs from 9 donors were ultimately used for 10 recipients. The 30-day mortality was 0%. Severe PGD requiring extracorporeal membrane oxygenation occurred in 1 patient. Median intensive care unit stay was 3.5 days (range, 2-21 days). Hospital stay was 25 days (range, 9-47 days). AR occurred in 2 patients. No early BOS has developed. Nine (90%) patients are alive at a median of 270 days (range, 47-798 days) with good performance status and lung function. One patient died of sepsis 17 months after transplantation.
DCD has steadily increased in Canada since 2006. The use of controlled DCD lungs for transplantation is associated with very acceptable early and intermediate clinical outcomes.
心脏死亡后器官捐献（DCD）有可能缓解部分肺移植供体短缺的问题。仅有有限的数据描述了DCD肺移植后的结果。本研究描述了加拿大DCD肺移植后的早期和中期结果。
收集了2006年6月至2008年12月期间参与DCD肺移植的供体和受体的数据。描述了肺DCD方案、供体特征以及移植后事件的发生情况，包括原发性移植物功能障碍（PGD）、支气管并发症、急性排斥反应（AR）、闭塞性细支气管炎综合征（BOS）和生存率。
成功的多器官控制性DCD从2006年的4例供体增加到2008年的26例。DCD供体中肺的利用率在2006年为0%，2007年为11%，2008年为27%。肺移植团队对13例DCD供体进行了现场评估，9例供体的肺最终用于10例受体。30天死亡率为0%。1例患者发生了需要体外膜肺氧合的严重PGD。重症监护病房中位住院时间为3.5天（范围2 - 21天）。住院时间为25天（范围9 - 47天）。2例患者发生了AR。未出现早期BOS。9例（90%）患者存活，中位时间为270天（范围47 - 798天），功能状态和肺功能良好。1例患者在移植后17个月死于败血症。
自2006年以来，DCD在加拿大稳步增加。使用控制性DCD肺进行移植与非常理想的早期和中期临床结果相关。
