Alderete Isaac S, Pontula Arya, Medina Cathlyn K, Halpern Samantha E, Klapper Jacob A, Neely Megan L, Snyder Laurie, Hartwig Matthew G
Duke University School of Medicine, Durham, North Carolina.
University of Manchester Medical School, Manchester, UK.
J Heart Lung Transplant. 2025 Apr;44(4):573-582. doi: 10.1016/j.healun.2024.11.013. Epub 2024 Nov 19.
Understanding donor factors associated with successful lung transplantation (LTx) following donation after circulatory death (DCD) is important in optimizing donor management. In this study, we examined critical care and ventilatory factors associated with DCD LTx and allograft survival using a unique detailed donor management database.
The Donor Management Goals national registry was queried for DCD donors between January 2016 and July 2023. The primary outcomes were DCD lung utilization and allograft survival. Multivariable modeling was used to assess factors associated with DCD LTx and allograft survival.
A total of 3,394 donors met inclusion criteria and were included. Transplantation occurred in 202 (6.0%) cases with 85.6% 1-year survival. DCD LTx was more likely to occur following cerebrovascular accidents compared to anoxia and from donors who achieved a targeted PaO/FiO (P/F) ratio at the time of organ allocation. Donor factors associated with decreased likelihood of LTx included increasing age, increasing INR, height greater than 168 cm, increasing hematocrit, and higher positive end-expiratory pressure (PEEP) at the time of organ allocation. Donor treatment with steroids and controlled mandatory ventilation, were associated with increased likelihood of graft failure at one year.
Successful DCD LTx associates with potentially modifiable donor parameters, including targeted P/F ratio, PEEP, INR, and hematocrit. Additionally, careful consideration of steroid use and ventilator settings may be important for improving long-term graft function. These modifiable factors may inform strategies to increase DCD LTx and improve survival.
了解与心脏死亡后器官捐献（DCD）后成功肺移植（LTx）相关的供体因素对于优化供体管理至关重要。在本研究中，我们使用一个独特的详细供体管理数据库，研究了与DCD-LTx和移植物存活相关的重症监护和通气因素。
查询2016年1月至2023年7月期间Donor Management Goals国家登记处的DCD供体。主要结局是DCD肺的利用率和移植物存活情况。采用多变量模型评估与DCD-LTx和移植物存活相关的因素。
共有3394名供体符合纳入标准并被纳入研究。202例（6.0%）进行了移植，1年生存率为85.6%。与缺氧相比，脑血管意外后更有可能发生DCD-LTx，并且在器官分配时达到目标氧合指数（PaO₂/FiO₂，P/F）的供体更易发生。与LTx可能性降低相关的供体因素包括年龄增加、国际标准化比值（INR）升高、身高大于168cm、血细胞比容增加以及器官分配时呼气末正压（PEEP）升高。供体使用类固醇和控制强制通气与1年时移植物失败的可能性增加相关。
成功的DCD-LTx与潜在可改变的供体参数相关，包括目标P/F比值、PEEP、INR和血细胞比容。此外，谨慎考虑类固醇的使用和呼吸机设置可能对改善长期移植物功能很重要。这些可改变的因素可能为增加DCD-LTx和提高生存率的策略提供参考。
