Lung management protocols increase the incidence of lung procurement and organ transplantation: A meta-analysis

Background: Improved donor management, including respiratory physiotherapy, may optimize donor suitability and increase successful lung procurement. This review aimed to determine the efficacy of lung management protocols on the incidence of successful lung procurement and transplantation. Methods: Searches were completed in MEDLINE, CINAHL, EMBASE, PubMed, PEDRO, and Cochrane Registry of Controlled Clinical Trials, from database inception to March 2018. Randomized controlled trials and observational studies, with a control or comparison group, of humans, published in English, in peer-reviewed journals were included. Any respiratory management was eligible. Two investigators assessed eligibility and study quality. Meta-analysis and narrative analysis were completed. Results: Ten of 430 articles identified were eligible for inclusion. Implementation of protocols in potential donors increased the incidence of lung procurement, odds ratio (OR), 95% CI: 3.42 (2.48, 4.71) and transplantation procedures OR 2.56 (1.41, 4.62) compared to control groups. Recipient survival was significantly higher, in favor of lung management protocols compared to control groups at 30 days (OR 2.37 (1.14, 4.95)) and 1 year (OR 1.82 (1.02, 3.27)). Pooling of randomized controlled trials was not possible due to heterogeneity between interventions. No studies reported adverse events associated with lung management protocols or the incidence of ventilator-associated pneumonia. Despite differences in intervention design and study quality, observational studies reported consistent direction and magnitude of effects in favor of protocolized interventions. Conclusions: Lung management protocols appear to increase transplantation success. High-quality randomized trials are warranted to test observed effects and ascertain the effects of specific protocol components on transplantation outcomes.