Lung Transplant Service, The Alfred Hospital, Melbourne, Victoria, Australia.
Toronto Lung Transplant Program, Toronto General Hospital and Hospital for Sick Children, Toronto, Ontario, Canada.
J Heart Lung Transplant. 2019 Jan;38(1):26-34. doi: 10.1016/j.healun.2018.08.006. Epub 2018 Aug 11.
In this study we aimed to assess the impact of agonal time and warm ischemic time on early survival in Category III donation-after-circulatory-death (DCD) donor lung transplants (LTxs) using data reported to the International Society for Heart and Lung Transplantation (ISHLT) DCD Lung Transplant Registry.
In this retrospective study, data were analyzed for 507 DCD LTxs done between January 2005 and June 2015. DCD lung donor agonal time (defined as withdrawal of life support to cessation of cardiac output) and warm ischemic time (WIT; defined as donor systolic blood pressure <50 mm Hg to cold pulmonary artery flush) were divided into 3 clinical timing categories (<30 minutes, 30 to 60 minutes, >60 minutes) and 3 tertiles. Univariate analysis was undertaken for all categorizations, and Day 30/Day 365 Kaplan‒Meier survival rates were calculated and compared. Multivariable analysis included Cox proportional hazards regression models to estimate hazard of 365-day mortality.
Four hundred sixty-five and 301 DCD LTxs had data to analyze in the agonal and warm ischemic time groups, respectively. Day 30 and Day 365 post-transplant survival overall were 96% and 90%, respectively, and not statistically different according to agonal or WIT category or tertile.
Current experience with DCD Category III LTx does not show a relationship between the duration of donor agonal phase or warm ischemic time up to 60 minutes and early survival. These results suggest the true limits of clinical DCD allograft warm ischemic times may not yet be reached. Global variations in clinical DCD practice are apparent. Continued accurate recording and analyses of DCD processes is warranted.
本研究旨在使用国际心肺移植学会（ISHLT）DCD 肺移植登记处报告的数据，评估濒死时间和热缺血时间对 III 类 DCD（脑死亡后循环停止）供体肺移植（LTx）早期存活的影响。
在这项回顾性研究中，分析了 2005 年 1 月至 2015 年 6 月期间进行的 507 例 DCD LTx 的数据。DCD 肺供体濒死时间（定义为停止心肺支持至心输出停止）和热缺血时间（WIT；定义为供体收缩压<50mmHg 至肺动脉冷冲洗）分为 3 个临床时间类别（<30 分钟、30-60 分钟、>60 分钟）和 3 个三分位数。对所有分类进行了单变量分析，并计算和比较了第 30 天/第 365 天 Kaplan-Meier 生存率。多变量分析包括 Cox 比例风险回归模型，以估计 365 天死亡率的危险比。
465 例和 301 例 DCD LTx 在濒死和热缺血时间组中有数据进行分析。移植后第 30 天和第 365 天的存活率分别为 96%和 90%，根据濒死或 WIT 类别或三分位数，差异无统计学意义。
目前对 DCD III 类 LTx 的经验表明，供体濒死期或热缺血时间长达 60 分钟与早期存活之间没有关系。这些结果表明，真正的临床 DCD 同种异体移植物热缺血时间限制可能尚未达到。临床 DCD 实践的全球差异是明显的。需要继续准确记录和分析 DCD 过程。
