Laboratory of Pneumology, Katholieke Universiteit Leuven, Leuven, Belgium.
J Heart Lung Transplant. 2011 Sep;30(9):975-81. doi: 10.1016/j.healun.2011.04.014. Epub 2011 Jun 12.
Donation after cardiac death (DCD) to overcome the donor organ shortage is now moving into the clinical setting, but the medium-term outcome after DCD lung transplantation (LTx) remains largely unknown.
In this retrospective study, DCD LTx recipients (n = 21) were compared with a cohort of donation-after-brain-death (DBD) LTx recipients (n = 154) transplanted between February 2007 and July 2010. Immediate (post)operative outcome was evaluated by assessing need for peri-operative extracorporeal membrane oxygenation (ECMO), time to extubation, hospital discharge and primary graft dysfunction (PGD) within the first 48 hours. Survival, incidence of bronchiolitis obliterans syndrome (BOS), acute rejection (AR) and inflammatory markers in blood and in bronchoalveolar lavage (BAL) were assessed and compared over a median follow-up of 327 days for DCD and 531 days for DBD, showing no statistically significant difference (NS).
There were no differences between groups with regard to patient characteristics except for a higher number of patients transplanted for obliterative bronchiolitis in the DCD group (4 of 21 vs 7 of 154; p < 0.05). In the DCD group, 2 of 21 patients died, vs 23 of 154 patients in the DBD group (NS). Actuarial survival rates at 6 months, 1 year and 3 years are 95%, 95% and 71% for the DCD group and 96%, 91% and 75% for the DBD group (NS). Three patients (14%) in the DCD group developed BOS vs 15 patients (10%) in the DBD group (NS). Survival and freedom from BOS were not different between the groups. AR, inflammatory markers and immediate (post)operative outcome also did not differ.
In our experience, both early- and medium-term outcome in DCD lung recipients is comparable to that of DBD lung recipients. Use of lungs recovered from controlled donors after cardiac death is a safe option for expansion of the donor pool.
为了克服供体器官短缺的问题，心脏死亡后捐献（DCD）已开始应用于临床，但 DCD 肺移植（LTx）的中期结果仍知之甚少。
在这项回顾性研究中，将 21 例 DCD LTx 受者与 2007 年 2 月至 2010 年 7 月期间接受脑死亡后捐献（DBD）LTx 的 154 例受者进行比较。通过评估围手术期体外膜肺氧合（ECMO）的需求、拔管时间、住院出院和 48 小时内原发性移植物功能障碍（PGD）来评估即刻（术后）的结果。在中位数为 327 天的 DCD 组和 531 天的 DBD 组中，评估并比较了生存、闭塞性细支气管炎综合征（BOS）的发生率、急性排斥反应（AR）和血液及支气管肺泡灌洗液（BAL）中的炎症标志物，未发现具有统计学意义的差异（NS）。
两组患者的特征除了 DCD 组中因闭塞性细支气管炎而接受移植的患者数量较多（21 例中有 4 例，154 例中有 7 例；p<0.05）外，无其他差异。在 DCD 组中，21 例患者中有 2 例死亡，而在 DBD 组中有 23 例患者死亡（NS）。DCD 组的 6 个月、1 年和 3 年的累积生存率为 95%、95%和 71%，而 DBD 组的生存率分别为 96%、91%和 75%（NS）。DCD 组中有 3 例（14%）患者发生 BOS，而 DBD 组中有 15 例（10%）患者发生 BOS（NS）。两组之间的生存和无 BOS 率无差异。AR、炎症标志物和即刻（术后）结果也没有差异。
根据我们的经验，DCD 肺受者的早期和中期结果与 DBD 肺受者相似。使用心脏死亡后受控供体捐献的肺是扩大供体池的安全选择。
