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Updated: Jan 4, 2026
Lung Rapid Recovery Procurement Combined with Abdominal Normothermic Regional Perfusion in Controlled Donation after Circulatory Death
Published on: August 15, 2022
Lung transplantation from donation after controlled cardiocirculatory death. Systematic review and meta-analysis
Alessandro Palleschi1, Lorenzo Rosso2, Valeria Musso3
1Thoracic Surgery and Lung Transplantation Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico of Milan, Milan, Italy.
Insights
Lung transplantation using controlled donation after circulatory death (cDCD) donors shows comparable short-term survival and primary graft dysfunction to donation after brain death (DBD) donors. Long-term outcomes and airway complications warrant further investigation.
Area of Science:
- Cardiovascular Sciences
- Transplantation Medicine
- Pulmonary Medicine
Background:
- Rising demand for lung allografts has renewed interest in donation after circulatory death (DCD) donors for lung transplantation (LT).
- Clinical outcomes following DCD lung transplantation have demonstrated satisfactory results.
- This systematic review analyzes outcomes of LT using controlled DCD (cDCD) versus donation after brain death (DBD) donors.
Purpose of the Study:
- To systematically review and analyze published data on lung transplantation outcomes comparing cDCD and DBD donors.
- To evaluate the efficacy and safety of lung allografts from cDCD donors.
Main Methods:
- A comprehensive literature search was conducted in Cochrane Database of Systematic Reviews, PubMed, and Web of Science.
- Relevant articles were independently assessed by two authors, with quality evaluation using NIH protocols.
- Pooled Odds Ratios and mean differences were calculated using random-effect models to analyze outcomes.
Main Results:
- Nine studies involving 2973 patients (403 cDCD, 2570 DBD) were included.
- No significant differences were observed in 1-year survival (OR=1.00) or primary graft dysfunction (PGD) (OR=1.03) between cDCD and DBD groups.
- Higher rates of airway complications (OR=2.07) and lower rates of chronic lung allograft dysfunction (CLAD) (OR=0.57) and 5-year survival (OR=0.57) were noted with cDCD, requiring further research.
Conclusions:
- Lung transplantation from cDCD donors yields comparable 1-year survival, PGD, and 1-year freedom from CLAD to DBD donors.
- While airway complications and long-term survival showed associations with cDCD, these findings require additional investigation.
- cDCD donors represent a viable option for lung transplantation, though specific complications need monitoring.
Background:
The interest in donation after cardiocirculatory death (DCD) donors for lung transplantation (LT) has been recently rekindled due to lung allograft shortage. Clinical outcomes following DCD have proved satisfactory. The aim of this systematic review is to provide a thorough analysis of published experience regarding outcomes of LT after controlled DCD compared with donation after brain death (DBD) donors.
Methods:
We performed a literature search in Cochrane Database of Systematic Reviews, PubMed and Web of Science using the items "lung transplantation" AND "donation after circulatory death" on November 1, 2018. The full text of relevant articles was evaluated by two authors independently. Quality assessment was performed using the NIH protocol for case-control and case series studies. A pooled Odds ratio (OR) and mean differences with inverse variance weighting using DerSimonian-Laird random effect models were computed to account for between-trial variance (τ2).
Results:
Of the 508 articles identified with our search, 9 regarding controlled donation after cardiac death (cDCD) were included in the systematic review, including 2973 patients (403 who received graft from DCD and 2570 who had DBD). Both 1-year survival and 2 and 3-grade primary graft dysfunction (PGD) were balanced between the two cohorts (OR = 1.00 and 1.03 respectively); OR for airway complications was 2.07 against cDCD. We also report an OR = 0.57 for chronic lung allograft dysfunction (CLAD) and an OR = 0.57 for 5-year survival against cDCD.
Conclusions:
Our meta-analysis shows no significant difference between recipients after cDCD or DBD regarding 1-year survival, PGD and 1-year freedom from CLAD. Airway complications and long-term survival were both related with transplantation after cDCD, but these statistical associations need further research.
