171.5 Surgeons Are Apprehensive to Use DCD Lungs Compared to DCD and DBD Abdominal Organs Despite Similar Post-Transplant Outcomes: A 20-Year UNOS Retrospective Analysis
University Health Network
Toronto, ON
Canada - Contact Me
Marcelo Cypel MD, MSc, FACS, FRCSC
Surgical Director Ajmera Transplant Centre at UHN
Surgical Director UHN ECLS Program
Canada Research Chair in Lung Transplantation
Professor of Surgery, Division of Thoracic Surgery
University of Toronto, University Health Network
Senior-Scientist, Toronto General Research Institute
Rabin Medical Center
Tel Aviv
Israel - Contact Me
J. Sam Meyer is a research fellow in the Division of Cardiovascular and Thoracic Surgery at the Rabin Medical Center under the guidance of Prof. Yaron Barac, focusing on heart and lung transplantation. He is currently pursuing his Medical Degree at Tel Aviv University as well as a Ph.D. in Biomedical Engineering at Ben Gurion University and working full time as a consultant at the WHO for the Regional European Director. He holds BA from Columbia University and Masters of Economics from the London School of Economics. He is working with Prof. Barac and Prof. Dan Aravot to implement a 3D printing workflow for organ procurement and size matching in heart and lung transplantation and conducting large scale data analyses on the United Network of Organ Sharing registry to identify donor characteristics and increase donor pools in DCD, and intracranial bleeding donors in conjunction with Duke University Medical Center. He continues to maintain his commitment to military reserve duty as a team leader in Unit 669.
Description
While the practice of procuring DCD organs has increased in recent years, procurement of DCD lungs, in particular, has not progressed as rapidly as other organs. Therefore, further research should investigate improvements to DCD lung recovery protocols to increase the total number recovered and thereby decrease waitlist mortality. However, expansion of DCD lung transplants requires comparing these indicators to DCD abdominal organ donors and applying similar parameters to improve the rate of DCD lung recovery.
Methods
We retrospectively analyzed UNOS data from the Scientific Registry of Transplant Recipients. All donors who donated at ≥1 organ between 10/1999-01/2019 were extracted from the UNOS registry and stratified initially according to DBD and DCD status, and then abdominal organ and lung recovery vs. abdominal organ recovery alone. Associated characteristics of potential DCD abdominal organ and lung donors were compared and a multivariate logistic model with ≥1 transplanted lung and ≥1 transplanted abdominal organ as the outcome was constructed to evaluate the independent effects of important predictors.
Results
Our data consisted of 17,071 DCD potential donors, 16,394 (96.1%) of whom had ≤1 abdominal organ recovered and 657 (3.9%) with both ≤1 abdominal organ and ≤1 lung. Between these cohorts, lung use was associated with blood type, cause of death, smoking history, insulin dependency at the time of transplant, history of diabetes, drug use, mechanism of death, hypertension, age, duration of resuscitation, LVEF, and P/F ratio (P < .001 for all variables). Multivariable regression analysis showed that DCD donors who died from suicide were 2.27 [95% 1.44, 3.57, p<0.001] times more likely, and those who died of intracranial hemorrhage were 9.06 [95% 2.9, 24.21, p<0.001] more likely, to have both an abdominal organ and a lung procured than those who died of natural causes. Lastly, donors with a smoking history were .286 [95% .21, .39, p<0.001] times less likely to have both an abdominal organ and a lung procure than nonsmokers who died of natural causes.
Conclusion
Despite comparable survival outcomes reported for DCD abdominal organs and lungs, this study highlights discrepancies in lung procurement practices that evaluate donor characteristics differently for DCD abdominal organs and lungs. Further study should investigate similar discrepancies in procuring specific abdominal organs.