Ahmed Hosam F, Kulshrestha Kevin, Hogue Spencer, Hossain Md Monir, Zhang Yin, Cherikh Wida S, Ashfaq Awais, Morales David L S, Hayes Don
Cincinnati Children's Hospital Medical Center, Cardiothoracic Surgery, Cincinnati, Ohio, United States.
Cincinnati Children's Hospital Medical Center, University of Cincinnati, Biostatistics and Epidemiology, Cincinnati, Ohio, United States.
Ann Am Thorac Soc. 2024 Oct 15;22(1):112-20. doi: 10.1513/AnnalsATS.202405-546OC.
Donation after circulatory death (DCD) lung transplantation has increased, but there is limited data in children. We sought to characterize the international experience of pediatric DCD lung transplant (LT) in comparison to donation after brain death (DBD) to address extreme donor organ shortages in children needing LT.
Using the International Society for Heart and Lung Transplantation (ISHLT) Thoracic Organ Transplant Registry, 1453 children (<18yo) LT recipients from January 2004 to June 2018 were identified: 34 (3%) were DCD and 1419 (97%) were DBD recipients. Post-transplant outcomes were compared between groups. Propensity score method was used to derive matched cohorts and were compared between groups.
DCD and DBD recipients were of similar age, with cystic fibrosis being the most frequent indication for LT in both groups (64.5% vs. 57.5%, respectively). Kaplan-Meier analysis demonstrated similar survival between DCD and DBD cohorts, whereas propensity score-matched recipients also identified similar post-transplant survival in both groups (P=0.098). Secondary analysis found that DCD LT recipients had a longer post-transplant length of hospital stay (unmatched cohorts: 36.5d vs. 20d, p=0.022; matched cohort: 26d vs. 19d, p=0.016), and shorter time to acute cellular rejection (ACR) (unmatched cohorts: 248d vs. 560d, p=0.039; matched cohorts: 248d vs. 1650d,p=0.059).
Due to DCD being a key contributor to the increasing number of lung transplants being performed worldwide, the results of this analysis support this organ donation approach in children requiring LT, which would increase access to donor organs. The identification of a potential shorter time to ACR needs further exploration as more DCD pediatric LTs are performed.
心脏死亡后器官捐献（DCD）肺移植数量有所增加，但儿童相关数据有限。我们试图描述儿童DCD肺移植（LT）与脑死亡后器官捐献（DBD）相比的国际经验，以解决需要LT的儿童供体器官极度短缺的问题。
利用国际心肺移植协会（ISHLT）胸器官移植登记处的数据，确定了2004年1月至2018年6月期间1453例年龄小于18岁的LT受者：34例（3%）为DCD受者，1419例（97%）为DBD受者。比较两组移植后的结果。采用倾向评分法得出匹配队列并进行组间比较。
DCD和DBD受者年龄相似，囊性纤维化是两组中LT最常见的指征（分别为64.5%和57.5%）。Kaplan-Meier分析显示DCD和DBD队列的生存率相似，而倾向评分匹配的受者在两组中也显示出相似的移植后生存率（P=0.098）。二次分析发现，DCD LT受者移植后的住院时间更长（未匹配队列：36.5天对20天，p=0.022；匹配队列：26天对19天，p=0.016），急性细胞排斥反应（ACR）的时间更短（未匹配队列：248天对560天，p=0.039；匹配队列：248天对1650天，p=0.059）。
由于DCD是全球肺移植数量增加的关键因素，本分析结果支持在需要LT的儿童中采用这种器官捐献方式，这将增加供体器官的可及性。随着更多DCD儿童LT手术的开展，ACR时间可能较短这一发现需要进一步探索。
