5-Year Results from the ISHLT DCD Lung Transplant Registry Confirm Excellent Recipient Survival from Donation after Circulatory Death Donors

Purpose To compare 5-year survival of lung transplant ( LTx ) recipients in donation after circulatory death ( DCD ) versus donation after brain-death ( DBD ) donors. Methods We examined the ISHLT Thoracic Transplant Registry data for LTx patients transplanted between 2003 and 06/2017 at 23 centers in North America, Europe and Australia participating in the DCD Registry. Distribution of continuous variables was summarized as median and interquartile (IQR) values. Mann-Whitney test was used to compare distribution of continuous variables and chi-square or Fisher's exact test for categorical variables. Kaplan-Meier survival rates after LTx during 2003-06/2016 were compared between DCD-III [Maastricht category III withdrawal of life sustaining therapy (WLST)] only and DBD using the log-rank test. Risk factors for 5-year mortality were investigated using Cox multivariate proportional-hazards model. Results The study cohort included 11,516 lung transplants, of which 1,090 (9.5%) were DCD transplants. DCD-III category comprised 94.1% of the DCD cohort. Among the participating centers, the proportion of DCD-LTx increased from 0.6% in 2003 to 15.2% in 2017. DCD donor management included extubation in 91%, intravenous heparin in 51% and pre-transplant normothermic ex-situ pulmonary allograft perfusion in 15%. Median time interval from WLST to cardiac arrest was 15 min [IQR: 11-22 min] and to cold flush 32 min [IQR: 26-41 min]. Compared to DBD, donor age was higher (47 [IQR: 34-55] vs 40 [IQR: 24-52] years), bilateral LTx was performed more often (88.3% vs 76.6%), more recipients had COPD/emphysema as transplant indication, and recipient hospital stay was longer (25 [IQR: 17-39] versus 18 [IQR: 12-29] days) in DCD-III (all p Conclusion This ISHLT DCD Registry report with 5-year follow-up demonstrated similar excellent long-term survival in DCD-III and DBD lung donor recipients in 23 experienced centers. These data support measures to implement and increase DCD LTx more widely.