Rodríguez Diego A, Del Río Francisco, Fuentes Manuel E, Naranjo Sara, Moradiellos Javier, Gómez David, Rubio Juan José, Calvo Elpidio, Varela Andrés
Servicio de Medicina Intensiva, Hospital Clínico San Carlos, Madrid, España.
Arch Bronconeumol. 2011 Aug;47(8):403-9. doi: 10.1016/j.arbres.2011.04.009. Epub 2011 Jun 21.
Uncontrolled donation after cardiac death (DACD) has become an alternative to lung transplantation with encephalic-death donation. The main objective of this study is to describe the incidence of clinically relevant events in the period of thirty days after lung transplant with uncontrolled DACD and the influence of factors depending on the donor and donation process as well.
Historical cohort study of 33 lung transplant receivers at Hospital Puerta de Hierro and Hospital Marqués de Valdecilla with 32 DACD from Hospital Clínico San Carlos from 2002 to 2008. We studied surgical and medical complications, primary graft dysfunction, acute rejection, pneumonia and mortality. We made an evaluation of the donor characteristics and donation procedure times (minutes).
Median age of recipients was 50.5 years (interquartile range, 38.5-58). There were 28 males and 5 females. Cumulative incidence of events in the first month was: pneumonia 10 (31.3%); primary graft dysfunction 15 (46.9%); rejection 12 (37.5%); mortality 4 (12.1%); medical complications 25 (78.1%); and surgical complications 18 (56.3%). Median time of cardiac arrest was higher in those who presented pneumonia (15 vs. 7.5; p = 0.027). Median time of cold ischemia was higher in those who presented surgical complications and mortality (436 vs. 343.5; p = 0.04; 505 vs. 410; p = 0.033, respectively), and median of total ischemia times were longer in the recipients who died (828 vs. 695; p = 0.036).
Uncontrolled DACD are a valid alternative for expanding the donor pool in order to mitigate the current shortage of lungs that are valid for transplantation. The incidence of complications is comparable with published data in the literature.
心脏死亡后非受控供体（DACD）已成为脑死亡供体肺移植的一种替代方式。本研究的主要目的是描述非受控DACD肺移植术后30天内临床相关事件的发生率以及供体和捐赠过程相关因素的影响。
对2002年至2008年在铁之门医院和瓦尔迪西利亚侯爵医院接受33例肺移植的患者进行历史性队列研究，这些患者的供体32例来自圣卡洛斯临床医院的DACD。我们研究了手术和医疗并发症、原发性移植功能障碍、急性排斥反应、肺炎和死亡率。我们对供体特征和捐赠程序时间（分钟）进行了评估。
受者的中位年龄为50.5岁（四分位间距，38.5 - 58岁）。男性28例，女性5例。第一个月事件的累积发生率为：肺炎10例（31.3%）；原发性移植功能障碍15例（46.9%）；排斥反应12例（37.5%）；死亡率4例（12.1%）；医疗并发症25例（78.1%）；手术并发症18例（56.3%）。发生肺炎者的心脏骤停中位时间更长（15对7.5；p = 0.027）。发生手术并发症和死亡者的冷缺血中位时间更长（分别为436对343.5；p = 0.04；505对410；p = 0.033），死亡受者的总缺血时间中位数更长（828对695；p = 0.036）。
非受控DACD是扩大供体库以缓解目前可用于移植的肺短缺的一种有效替代方式。并发症的发生率与文献中已发表的数据相当。
