Lungs donated after cardiac death (DCD) are well comparable with conventional lungs donated after brain death (DBD)
A growing number of experimental and clinical studies are providing accumulating evidence that clinical outcomes after transplantation of lungs from cardiac /circulatory death donors (DCDs) are similar to those from conventional donors retrieved after brain death (DBDs or BDDs).
Two recent publications suggest that this equivalence of DCD and DBD lungs applies irrespective of whether the lungs were accepted for transplantation after conventional cold preservation or if they were also subjected to warm ex-vivo lung perfusion (EVLP) prior to their transplantation.
The latest interim findings from the US NOVEL multicenter trial on EVLP of initially rejected lungs (Whitson B A, et al, 2018), for example, revealed no significant difference in post-transplant outcomes, including survival, between 71 DBD lungs and 24 DCD lungs, both of which were subjected to EVLP employing the “Toronto” protocol performed on Xvivo´s XPS machine.
Virtually all important donor variables were comparable, and there were no differences in recipient variables, including underlying disease, age, gender, LAS, EVLP run time, etc.
After transplantation, the authors report no significant differences in outcome between DCDs and BDD/DBD lungs subjected to EVLP in terms of Primary Graft Dysfunction (PGD) at 24 hours, 48 hours or 72 hours after transplant, or in long-term survival between BDD, DCD, and control recipients (p=0.08). The authors conclude, “DCD recovery assessed via EVLP prior to transplantation is a viable option to expand the donor pool with good clinical outcomes.”
Other recent data from lungs subjected to cold static preservation alone also suggests similar outcomes after transplant of DCD versus DBD lungs. Costa J et al, 2018 for example, compared outcomes after transplantation of 46 DCD (Maastricht cat.III) lungs donated after circulatory /cardiac death with 237 conventional brain death (DBD) lungs over a nine-year period from a single center (Columbia, NY).
Here again, there were no significant differences in outcome between DCD lungs and those retrieved after brain death. PGD rates at 72 hours were essentially equivalent as were also one- and three-year survival rates.
- Whitson B A et al. Ex-Vivo Lung Perfusion in Donation After Circulatory Death Lung Transplantation Increases Donor Utilization: Analysis of the NOVEL Extension Trial J Heart Lung Transplant Vol 37, Issue 4, Supplement, April 2018, Pages S147-S148 (link to abstract)
- Costa J, et al, Use of Lung Allografts from Donation after Cardiac Death donors: A single-center experience. Ann Thorac Surg 2018;105:271–8) (link to abstract)
Xvivo Insights PB-2018-05-20