Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
Ann Thorac Surg. 2018 Dec;106(6):1619-1627. doi: 10.1016/j.athoracsur.2018.07.024. Epub 2018 Sep 8.
Lung transplants from donation after circulatory death (DCD) have been scarcely used in the United States. Concerns about the warm ischemic injury, resource mal-utilization due to the uncertain timing of death, and public scrutiny may be some factors involved.
Survival for recipients of a donation after brain death (DBD) versus DCD was analyzed by using the United Network for Organ Sharing and our institutional database. A propensity-matching and Cox regression analysis was performed for 25 characteristics. Primary graft dysfunction metrics were compared.
A total of 389 of 20,905 lung transplantations (2%) were performed by using DCDs in the United States, and 15 of 128 (12%) at our institution. Five and 10-year survival for DBDs was 55% and 30% and 59% and 33% for DCDs, respectively. Propensity-matched analysis of 311 DBD/DCD pairs did not demonstrate any difference in survival. On Cox regression, DCD was not associated with impaired survival. Male sex, Karnofsky class greater than 50, double lung transplantation, and transplantation year were predictors of improved survival. Age, creatinine, pulmonary fibrosis, retransplantation, extracorporeal membrane oxygenation, allocation score, and donor age were predictors of worse survival. Primary graft dysfunction at time 0 was worse for recipients of DCDs (p = 0.005) but equivalent at 24, 48, and 72 hours.
DCD lung transplants remain underused in the United States. Nevertheless, survival is similar to DBD. Primary graft dysfunction metrics for DCDs are worse than DBDs on intensive care arrival but improved subsequently.
在美国，很少使用来自心死亡后捐献（DCD）的肺移植。对热缺血损伤的担忧、由于死亡时间不确定而导致的资源浪费，以及公众的审查可能是一些相关因素。
使用美国器官共享联合网络（United Network for Organ Sharing）和我们的机构数据库，分析脑死亡供体（DBD）与 DCD 受体的存活率。对 25 个特征进行倾向匹配和 Cox 回归分析。比较原发性移植物功能障碍指标。
在美国，共有 389 例（2%）肺移植采用 DCD，在我们机构有 15 例（12%）。DBD 的 5 年和 10 年存活率分别为 55%和 30%，DCD 分别为 59%和 33%。对 311 对 DBD/DCD 进行倾向匹配分析，未发现存活率存在差异。Cox 回归分析显示，DCD 与存活率下降无关。男性、卡诺夫斯基评分大于 50、双肺移植和移植年份是存活率提高的预测因素。年龄、肌酐、肺纤维化、再次移植、体外膜氧合、分配评分和供体年龄是存活率下降的预测因素。DCD 受体的原发性移植物功能障碍在 0 时更差（p=0.005），但在 24、48 和 72 小时时相当。
美国 DCD 肺移植的应用仍然不足。然而，存活率与 DBD 相似。DCD 的原发性移植物功能障碍指标在重症监护到达时比 DBD 更差，但随后有所改善。
