A Global Experience of Donation after Circulatory Death for Pediatric Lung Transplantation

Rationale: Donation after circulatory death (DCD) lung transplantation (LT) has increased, but there are limited data in children. Objectives: We sought to characterize the international experience of pediatric DCD LT in comparison with donation after brain death (DBD) to address extreme donor organ shortages in children needing LT. Methods: Using the International Society for Heart & Lung Transplantation Thoracic Organ Transplant Registry, 1,453 children (<18 yr of age) lung transplant recipients from January 2004 to June 2018 were identified: 34 (3%) were DCD and 1,419 (97%) were DBD recipients. Post-transplantation outcomes were compared between groups. The propensity score method was used to derive matched cohorts, which were compared between groups. Results: DCD and DBD recipients were of similar age, with cystic fibrosis being the most frequent indication for LT in both groups (64.5% vs. 57.5%, respectively). Kaplan-Meier analysis demonstrated similar survival between the DCD and DBD cohorts, whereas propensity score-matched recipients also identified similar post-transplantation survival in both groups (P = 0.098). Secondary analysis revealed that DCD lung transplant recipients had a longer post-transplantation length of hospital stay (unmatched cohorts, 36.5 vs. 20 d [P = 0.022]; matched cohorts, 26 vs. 19 d [P = 0.016]) and shorter time to acute cellular rejection (unmatched cohorts, 248 vs. 560 d [P = 0.039]; matched cohorts, 248 vs. 1,650 d [P = 0.059]). Conclusions: Because DCD is a key contributor to the increasing number of LTs being performed worldwide, the results of this analysis support this organ donation approach in children requiring LT, which would increase access to donor organs. The identification of a potential shorter time to acute cellular rejection needs further exploration as more DCD pediatric LTs are performed.