Growing single-center experience with lung transplantation using donation after cardiac death

Early experience with lung transplantation (LTx) using organs from donors after cardiac death (DCD) has been promising, although widespread adoption has been slow because of the perception of diminished organ quality. Some centers have even suggested that use of DCD lungs is high risk and have recommended ex vivo evaluation before transplantation. We analyzed our growing single-center experience with DCD lungs procured and transplanted using protocols established for brain-dead donors.

From August 2004 to July 2011, 605 patients underwent LTx, 32 (4.9%) with DCD organs. Standardized donor selection, procurement, and preservation protocols established for brain-dead donors were applied to DCD organs. Measured outcomes were Kaplan-Meier survival, early graft function measured by arterial partial pressure of oxygen/fraction of inspired oxygen (PO2/FIO2 ratio [P/F ratio]), airway complications, spirometry, and development of bronchiolitis obliterans syndrome (BOS).

Survival was 97% at 30 days, 91% at 1 year, 91% at 2 years, and 71% at 3 and 4 years. Mean P/F ratio at 6 hours and 24 hours was 305 and 332, respectively. One airway complication required intervention. Median time to extubation, intensive care unit (ICU), and total hospital lengths of stay were 1, 4, and 14 days, respectively. At median follow-up of 2.8 years, median forced expiratory volume in 1 second, percent of predicted (FEV1%) of the survivors was 59% (range, 27%-113%), with 16% (5/32) having BOS.

This growing experience suggests that recipient survival and early graft function using DCD lungs is excellent and has occurred without significant adjustment of procurement, preservation, or implantation protocols. Concerns over diminished organ quality are unfounded, and use of DCD lungs should be expanded.