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Pulmonary Procedures |

Lung Transplantation From Donation After Cardiac Death: A Systematic Review and Meta-analysis

Dustin Krutsinger, MD; Amy Blevins, MA; Michael Eberlein, MD
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University of Iowa, Iowa City, IA


Chest. 2014;146(4_MeetingAbstracts):724A. doi:10.1378/chest.1989300
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Abstract

SESSION TITLE: Hot Topics in Pulmonary & Critical Care

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Sunday, October 26, 2014 at 01:30 PM - 03:00 PM

PURPOSE: Lung transplantation (LTx) represents a unique lifesaving therapy for patients suffering from endstage lung disease. Listing of patients in need of LTx has been constantly increasing, but the number of organ donors has remained mostly static. There is increasing experience with using lungs from donation after cardiac death (DCD) for LTx. It is unclear, if LTx after DCD is associated with differences in survival of LTx recipients compared to traditional donation after brain death (DBD), as the available literature consists of small, mostly single center studies. We sought to perform a systematic review of the available literature and a meta-analysis to compare survival outcomes among recipients of organs donated following DCD to organs donated following DBD.

METHODS: An extensive search of multiple databases using subject headings and keywords was performed. Search also consisted of reviewing selected article’s reference lists, hand sorting and contacting authors of selected studies for updated data. Inclusion criteria consisted of full text articles with 1 year survival data after LTx among both controlled donation after DCD and DBD cohorts and greater than 5 DCD transplants. One year survival after LTx was examined using meta-analysis.

RESULTS: 519 unique citations were found with the above search strategy. 58 were selected for full text review. 10 studies met our inclusion criteria for systematic review and 5 studies met our inclusion criteria for meta-analysis. All studies were observational cohort studies. Across individual studies there was no significant difference in 1 year survival after LTx between DCD and DBD cohorts. No significant heterogeneity was seen for 1 year mortality (I2= 0%; P = 0.658). In a pooled analysis of the 5 studies there was no significant difference in risk of death at 1 year after LTx with DCD vs DBD (RR 0.66, 95% CI 0.38-1.15, p = 0.15).

CONCLUSIONS: Survival following lung transplantation from donation after cardiac death is comparable to donation after brain death in observational cohort studies. Donation after cardiac death appears to be a safe and effective method to expand the donor pool.

CLINICAL IMPLICATIONS: Use of organs following determination of cardiac death for lung transplant has been slow to increase, due in part to concern about ischemic injury impacting organ function. This study adds to the body of evidence and supports the use of these organs as a safe and effective method to expand the donor pool for lung transplantion.

DISCLOSURE: The following authors have nothing to disclose: Dustin Krutsinger, Amy Blevins, Michael Eberlein

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