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Lung Transplantation Using Donation after Cardiac Death Donors: Long-term Follow-up in a Single Center
Satoru Osaki1, James D. Maloney1, Keith C. Meyer2, Richard D. Cornwell2, Holly K. Thomas1, Niloo M. Edwards1, Nilto C. De Oliveira1; 1Division of Cardiothoracic Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI; 2Section of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
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Objective: The shortage of donor organs is the most critical problem in solid organ transplantation. In an attempt to solve this, donation after cardiac death (DCD) donors have been proposed as an additional source of donor organs. Although short-term outcomes after DCD lung transplantation (LTx) have been described, there are no long-term survival reports and the susceptibility to injury and post-transplant reliability of DCD lung allograft are unclear. This study examines our institutional experience in DCD LTx after 1993.
Methods: Between 1993 and 2007, 365 consecutive patients underwent LTx at a single center. Among these patients, 17 (4.7%) patients had LTx from DCD donors. Patients transplanted from DCD donors (DCD group, n=17) were compared to patients transplanted from brain dead donors (BDD group, n=348).
Results: Patient demographics, donor age, and cold ischemic time did not differ between the groups: recipient age (DCD: 49 ± 12 yrs vs BDD: 49 ± 12 yrs, p = 0.89), distribution of diagnosis (% of chronic obstructive lung disease; 47% vs 38%, p = 0.97), donor age (28 ± 13 yrs vs 31 ± 14 yrs, p = 0.29), bilateral LTx procedure (40% vs 41%, p = 0.55), and cold ischemic time (363 ± 145 min vs 381 ± 106 min, p = 0.70). Warm ischemic time (from withdrawal of support to reperfusion of organs) was 33 ± 17 min (range: 18-89 min, 10 DCDs <30 min). The survival rates in the DCD group at 1, 2 and 5 yrs were 88%, 88% and 80%, respectively (median follow-up, 1075 days; range, 1-3210). These survival rates were not different from those of the BDD group (Log-rank test; p = 0.81, Figure). In the DCD group, 5 patients died. Causes of death were: small bowel infarction and multiple system organ failure (MSOF) on day 1, bronchiolitis obliterans (BOS) on day 305, metastatic colon cancer after 2.91 yrs, non-small cell cancer on native lung after 5.59 yrs, and MSOF after 8.79 yrs. 3 DCD patients required redo LTx (2 for BOS on day 91 and 8.55 yrs and 1 for bronchial dehiscence on day 22).
Conclusion: Our data shows that the long term patient survival after DCD LTx was equivalent to that after BDD LTx. Although the number is small and further evaluation is necessary to confirm our findings, our data substantiated excellent short-term survival. The use of DCD donors will substantially expand the donor pool for LTx.

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