Donation after Circulatory Death Donors Are Associated With Increased 1-Year Mortality After Lung Transplantation: A...

The use of donation after circulatory death (DCD) donors has significantly increased in recent years. The current study sought to risk-stratify transplants where DCD donors are utilized.

We reviewed the UNOS database for adult patients who underwent lung transplantation (LT) using DCD donors between 2017 and 2022 (n = 948, 6.31% of all LT). One-year mortality was the primary dependent variable.

The proportion of DCD donors is increasing (3.7% in 2017 to 7.6% in 2022, p < 0.001) and is associated with significantly higher 1-year mortality (13.9% vs. 10.7% among recipients of brain dead donors; p = 0.003). On Cox proportional hazard analysis with bootstrap validation, recipient age > 65 years (adjusted hazards ratio, 95% CI: 1.51, 1.05-2.2; p = 0.028), admission to the ICU at the time of transplant (2.11, 1.34-3.31; p = 0.001), estimated GFR < 75 mL/min/1.73 m² at the time of transplant (1.81, 1.23-2.67; p = 0.003), and organ out of body time >7 h (2.02, 1.39-2.94; p < 0.001) are associated with 1-year mortality. A composite variable, the recipient risk score, based on the number of above risk factors, is strongly associated with 1-year mortality.

The utilization of DCD donors is associated with worse 1-year mortality after LT. The recipient risk score based on the four simple-to-use recipient and procedure-related variables strongly predicts outcomes.