Assessing Lung Transplant Survival Following Donation after Cardiac Death: A Single Center Experience

Purpose This study sought to compare survival outcomes of lung transplant (LTx) patients who received a lung from a donor after brain death (DBD) or donor after cardiac death (DCD) using institutional data. Methods A single center, retrospective review identified 609 lung transplants performed between March 2012 and July 2019. Because only 14/609 LTx were DCD, DCD recipients were propensity score matched with DBD recipients. Propensity scores (PS) were determined using patient age, sex, race, diagnosis, BMI, CPB or ECMO use during surgery, and donor age. The PS model was verified by comparing 1:1, 1:3, and 1:5 pooled groups, and performing t-tests or chi-square analyses before and after matching. Survival outcomes were determined using Kaplan-Meier curves and log-rank tests. Results In total, 609 lung transplants were performed at our institution. Of these, 14 received a DCD lung. The mean age of the DCD group was 64.2 (sd = 5.7), and mean BMI was 29.2 kg/m2 (sd = 4.15). Mean donor age for DCD lungs was 31.9 (sd = 14.0). The PS matched DBD group did not significantly differ from the DCD group by age (p = 0.520), sex (p = 0.617), diagnosis (p = 0.414), pump use (p = 0.827), BMI (p = 0.178), or donor age (p = 0.240). For DCD recipients, the 30 day, 90 day, and 1 year survival was 100%, 100%, and 91%, respectively. For DBD recipients, 30 day, 90 day, and 1 year 95.7%, 94.2%, and 83.7%, respectively. A log-rank test of the PS matched data showed no significant difference in survival between DCD and DBD lungs, p=0.372. This finding was consistent across the 1:1, 1:3, and 1:5 PS matched groups. Conclusion Our experience indicates that DCD and DBD donor lungs provide comparable short-term survival. This finding agrees with other recent results, suggesting DCD donor lungs are a viable alternative and their use can be expanded.