A Multicenter Study on Long‐Term Outcomes After Lung Transplantation Comparing Donation After Circulatory Death and Donation After Brain Death

• Published in: American journal of transplantation Vol. 17; no. 10; pp. 2679 - 2686
• Main Authors: Suylen, V., Luijk, B., Hoek, R. A. S., Graaf, E. A., Verschuuren, E. A., Van De Wauwer, C., Bekkers, J. A., Meijer, R. C. A., Bij, W., Erasmus, M. E.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Limited 01.10.2017
• Subjects: Adult; Brain Death; bronchiolitis obliterans (BOS); Cardiovascular System - physiopathology; clinical research/practice; Death; donors and donation: donation after brain death (DBD); donors and donation: donation after circulatory death (DCD); Female; Graft Rejection; Humans; lung (allograft) function/dysfunction; Lung - physiopathology; Lung Transplantation; lung transplantation/pulmonology; Lung transplants; Lungs; Male; Middle Aged; Netherlands; Organ donors; organ procurement and allocation; organ transplantation in general; patient survival; Respiratory function; Survival; Survival Analysis; Tissue and Organ Procurement; Transplantation; Transplants & implants; Treatment Outcome; Xenografts; Netherlands; lung (allograft) function/dysfunction; bronchiolitis obliterans (BOS); patient survival; organ transplantation in general; clinical research/practice; organ procurement and allocation; lung transplantation/pulmonology; donors and donation: donation after circulatory death (DCD); donors and donation: donation after brain death (DBD)
• ISSN: 1600-6135; 1600-6143
• DOI: 10.1111/ajt.14339

The implementation of donation after circulatory death category 3 (DCD3) was one of the attempts to reduce the gap between supply and demand of donor lungs. In the Netherlands, the total number of potential lung donors was greatly increased by the availability of DCD3 lungs in addition to the initial standard use of donation after brain death (DBD) lungs. From the three lung transplant centers in the Netherlands, 130 DCD3 recipients were one‐to‐one nearest neighbor propensity score matched with 130 DBD recipients. The primary end points were primary graft dysfunction (PGD), posttransplant lung function, freedom from chronic lung allograft dysfunction (CLAD), and overall survival. PGD did not differ between the groups. Posttransplant lung function was comparable after bilateral lung transplantation, but seemed worse after DCD3 single lung transplantation. The incidence of CLAD (p = 0.17) nor the freedom from CLAD (p = 0.36) nor the overall survival (p = 0.40) were significantly different between both groups. The presented multicenter results are derived from a national context where one third of the lung transplantations are performed with DCD3 lungs. We conclude that the long‐term outcome after lung transplantation with DCD3 donors is similar to that of DBD donors and that DCD3 donation can substantially enlarge the donor pool. This multicenter study demonstrates that lung transplantation using donation after circulatory death category 3 donors yields excellent short‐ and long‐term outcomes similar to donation after brain death. Bozso and Nagendran's editorial is on page 2507.