Division of Thoracic and Cardiovascular Surgery, University of Florida Health, Gainesville, FL, United States.
Division of Cardiac Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, United States.
Transpl Int. 2022 Apr 4;35:10172. doi: 10.3389/ti.2022.10172. eCollection 2022.
Use of lungs donated after circulatory death (DCD) has expanded, but changes in donor/recipient characteristics and comparison to brain dead donors (DBD) has not been studied. We examined the evolution of the use of DCD lungs for transplantation and compare outcomes to DBD lungs. The SRTR database was used to construct three 5-year intervals. Perioperative variables and survival were compared by era and for DCD vs. DBD. Geographic variation was estimated using recipient permanent address. 728 DCD and 27,205 DBD lung transplants were identified. DCD volume increased from Era 1 ( = 73) to Era 3 ( = 528), representing 1.1% and 4.2% of lung transplants. Proportionally more DCD recipients were in ICU or on ECMO pre-transplant, and had shorter waitlist times. DCD donors were older, had lower PaO2/FiO2 ratios compared to DBD, more likely to be bilateral, had longer ischemic time, length of stay, post-op dialysis, and increased use of lung perfusion. There was no difference in overall survival. Geographically, use was heterogeneous. DCD utilization is low but increasing. Despite increasing ischemic time and transplantation into sicker patients, survival is similar, which supports further DCD use in lung transplantation. DCD lung transplantation presents an opportunity to continue to expand the donor pool.
使用心跳死亡（DCD）供体捐献的肺已经扩大，但供体/受体特征的变化以及与脑死亡（DBD）供体的比较尚未研究。我们研究了使用 DCD 肺进行移植的演变，并将结果与 DBD 肺进行比较。使用 SRTR 数据库构建了三个 5 年时间间隔。通过时代和 DCD 与 DBD 比较了围手术期变量和生存率。使用受者永久地址估计了地域差异。确定了 728 例 DCD 和 27205 例 DBD 肺移植。DCD 量从第 1 时代（=73）增加到第 3 时代（=528），代表肺移植的 1.1%和 4.2%。与 DBD 相比，更多的 DCD 受者在移植前在 ICU 或 ECMO 中，等待时间更短。DCD 供者年龄较大，PaO2/FiO2 比值较低，更可能是双侧的，缺血时间较长，住院时间较长，术后透析时间较长，肺灌注使用率增加。总生存率无差异。在地理上，使用存在异质性。DCD 的使用率虽然低，但在增加。尽管缺血时间延长且移植到病情较重的患者，但生存率相似，这支持进一步在肺移植中使用 DCD。DCD 肺移植为继续扩大供体库提供了机会。
