Lung Transplant Service, Alfred Hospital and Monash University, Melbourne, Vic, Australia.
Lung Transplant Service, Alfred Hospital and Monash University, Melbourne, Vic, Australia.
Heart Lung Circ. 2020 May;29(5):793-799. doi: 10.1016/j.hlc.2019.04.007. Epub 2019 Apr 26.
Australia's increasing organ donor rate has translated to increased lung donor referrals and subsequent lung transplantation (LTx). The LTx sector attempts to utilise as many organs as possible-but in reality, not all are used. This analysis aims to assess the utility and efficiency of donor lung referrals to the Alfred Hospital.
All Donatelife Australia donor lung referrals for the year 2017 were analysed retrospectively.
From a total of 440 lung referrals, 220 were local from the state of Victoria (population 6.4 million) and 220 from the Rest-of-Australia (ROA). Sixty-eight per cent (68%) of Victorian and 48% of the ROA were via the donation after circulatory death (DCD) pathway. One hundred and two (102) LTx were performed: 32 represent 21% of 149 Victorian and 8% of 106 ROA DCD donors, 70 represent 54% of the Victorian and 24% of the ROA donation after brain death (DBD) donors. Eighty per cent (80%) of all donors aged <35 and 30% >35 years were used or potentially useable. Thirteen per cent (13%) of DCD and 44% of DBD donors aged >65 years were used. Logistical and resource considerations, around the retrieval of older DCD lungs, are a significant issue. At 11.1 LTx per-million-population the Alfred has one of the highest lung donor conversion and LTx activity rates in the world.
The Australian donor lung pool could still be further extended by focussing effort and logistics on optimising DBD referrals. Additional resources (staff and transport), tighter referral criteria, and the use of extended warm ischaemic time donors could increase particularly DCD recovery rates.
澳大利亚不断增加的器官捐献者比例导致肺捐献者的推荐数量增加，继而进行了更多的肺移植（LTx）。LTx 部门试图尽可能多地利用器官，但实际上并非所有器官都被使用。本分析旨在评估向阿尔弗雷德医院提交的供体肺的使用情况和效率。
回顾性分析了 2017 年所有 Donatelife Australia 供体肺的推荐情况。
在总共 440 例肺推荐中，220 例来自维多利亚州（人口 640 万），220 例来自澳大利亚其他地区（ROA）。68%的维多利亚州病例和 48%的 ROA 病例通过心脏死亡后捐献（DCD）途径。共进行了 102 例 LTx：32 例代表 149 例维多利亚州 DCD 供体中的 21%和 106 例 ROA DCD 供体中的 8%，70 例代表 149 例维多利亚州 DBD 供体中的 54%和 106 例 ROA DBD 供体中的 24%。80%的所有 <35 岁的供体和 30%>35 岁的供体都被使用或具有潜在可用性。13%的 DCD 供体和 44%的 DBD 供体>65 岁被使用。围绕获取老年 DCD 肺的后勤和资源考虑因素是一个重大问题。Alfred 医院每百万人口 11.1 例 LTx，是世界上肺供体转化率和 LTx 活动率最高的医院之一。
通过集中精力和后勤资源优化 DBD 推荐，澳大利亚的供体肺库仍有进一步扩大的空间。增加额外的资源（人员和运输）、更严格的推荐标准以及使用延长的热缺血时间供体可以提高特别是 DCD 的恢复率。
