First comparison between lungs donated after uncontrolled circulatory death and those donated after conventional brain death
At long last, the first comparison of long-term results after transplantation of lungs donated after uncontrolled circulatory death (uDCD) versus those from conventional brain dead (BD) donors has been published(6). It is fitting that this study emanates from Madrid, possibly the foremost global pioneer in the utilization of organs retrieved from donors after uncontrolled circulatory death.
The theoretical potential for access to uDCD lungs is of course well beyond that of lungs derived from both brain dead or circulatory dead patients who have been in formal medical care. But despite the quite substantial theoretical potential of uncontrolled lungs, the complications and logistics of effectively utilizing organs with often unknown histories and ischemic times have severely restricted their use. However, Spain, (and Madrid in particular), has been a true pioneer in this field, in part due to the country’s donation legislation.
Varela’s group in Madrid performed a retrospective analysis of all lung transplants performed between 2002 and 2012: a total of 292 lung transplants from BD donors and 38 uDCD donors. Both groups were comparable, except there were more male donors among the uDCD group, total ischemic time for the uDCD group was almost twice as long (11-13 hours) and EVLP was more frequent in the uDCD group. Despite these differences, early and late outcomes for transplant recipients were not different, including time in ICU, length of hospital stay, PGD rates and chronic graft dysfunction. Overall survival, however, was significantly lower for patients who had received lungs from uDCD donors.
The authors conclude, “Lung transplantation after uncontrolled cardiac death offers poorer results in terms of survival compared to brain death donation. Refinement of current strategies for graft preservation and evaluation is essential to improve outcomes with this source of grafts”.
6. Valdivia D et al, Expanding the horizons: Uncontrolled donors after circulatory death for lung transplantation – First comparison with brain death donors. Clin Transplant. 2019 Apr 2:e13561. doi: 10.1111/ctr.13561. [Epub ahead of print] (link to abstract)
Xvivo Insights PB-2019-06-27