Kashem, A., Villavicencio, M., Ius, F., Loor, G., Hartwig, M., Ghadimi, K., Salman, J., Chandrashekaran, S., Machuca, T., Sanchez, P., Subramaniam, K., Van Raemdonck, D., Neyrinck, A., Warnick, M., Huddleston, S., Osho, A., D'Silva, E., Ramamurthy, U., Pena, A. Leon, and Shaffer, A.
Previously we have reported our interim results on donation after circulatory death that is propagated to expand the lung transplant (LTx) organ donor pool. Using the International ECLS Registry database, we further compared in a substantial larger group consisting of donation after circulatory death and braindead (DCD vs. DBD) LTx survival in the context of intraoperative extracorporeal life support (ECLS). We hypothesized comparable survival outcomes and ECLS usage between donor groups. Patient data involving lung transplants from 1488 patients were collected from multiple institutions through the National ECLS Registry, and stratified by donor technique (DCD, DBD, EVLP). ECLS usage information was obtained and analyzed with Chi-square testing or Fisher's exact test to determine a relationship with donor groupings. Lung transplant procedure details, patient and donor demographics and post-operative outcomes such as survival were analyzed using Wilcoxon rank sum test or Chi-square testing to determine distribution. Propensity score matching was used in combination with Kaplan-Meier survival curves with log-rank testing to assess mortality between donor groups with and without ECLS. P values <0.05 was considered statistically significant. Analysis of differences in patient/donor demographics, preoperative, intra-operative and post-operative ECLS usage, post-operative complications, and patient survival were used to compare the DCD and DBD donor groups. A total of 1488 double lung transplantations (DLT), 121 DCD and 1367 DBD cases, were preliminarily analyzed. Out of these patients, there were 154 EVLP cases, 35 EVLP in DCD and rest (n=119) in DBD group. DCD had older donor age (p=0.01), and higher post-operative pneumonia rates in DCD (p=0.01). Groups were different in the type of intra-operative ECLS support required for 89 cases (16 CPB, 50 ECMO, 14 Modified bypass cases) (p=0.01), total ischemic time (p=0.0001), and post-op ECMO (p=0.06). Mortality analysis showed no increased risk for DCD vs DBD groups before discharge, at 90-days, and 1-year. K-M figure showed graph before and after propensity matching with/without ECLS. Multi-center registry data indicated no differences in survival outcome whether DCD or DBD donors were used. Further long-term follow-ups are needed to validate proper DCD utilization. [ABSTRACT FROM AUTHOR]