PS67. Short and Long-Term Results of Lung Transplantation in Donors from Circulatory vs Brain death: a Meta-analysis of Comparative Studies

Los Angeles Convention Center 

Objectives: Donation after Circulatory Death (DCD) donors for lung continues to be underutilized in the United States. Through a meta-analysis of comparative studies, we investigated the impact of procurement strategy donation after brain death (DBD) versus DCD on the short- and long-term outcomes of lung transplantation.
Methods: We performed a systematic literature search using the items “lung transplantation” AND “donation after circulatory death” from inception till July 2022 for studies comparing outcomes of lung transplantation from DCD versus DBD. Variables extracted included recipient & donor characteristics, short- and long-term outcomes. Primary endpoints were early mortality, primary graft dysfunction (PGD), acute rejection, and long-term survival. A pooled Odds ratio (OR) and mean differences with inverse variance weighting using random effect models were computed to account for between-trial variance (τ2). Heterogeneity among the trials was quantified by I2-index and Cochran's Q test.
Results: Of the 2937 total studies, 48 manuscripts were assessed for full text review. Nine studies comparatively reported data on the short-term outcomes and 18 studies reported long-term survival for both groups. We included 70,784 patients, of whom 68,280 were transplanted after DBD and 2,504 after DCD. They were mostly male (57%) and their mean age was 50.8 years. No publication bias was observed by funnel plot. The estimated pooled odds ratio (OR) of early mortality resulting from 9 studies favored DBD with a total of 1,291 events over 28,912 patients (4.46%) versus 55 events over 1,060 patients (5.18%) in the DCD group (OR 0.73 CI 0.55-0.98 with a 0% heterogeneity). No statistically significant difference was observed regarding the risk of acute rejection (OR 1.19 CI 0.94-1.68) and PGD grade 2-3 (OR 0.91 CI 0.72-1.14). The estimated pooled odds ratio of 1-year mortality cumulative incidence resulting from 18 studies with a total of 40,148 patients was 1.02 (CI 0.86-1.21), at 3 years was 0.89 (0.66-1.20) and at 5 years was 0.97 (CI 0.81-1.16).
Conclusions: This is the first meta-analysis of comparative studies between DCD and DBD demonstrating increased early mortality in DCD lung transplant. However, there was no difference in PGD, acute rejection and long-term survival at 1,3 and 5 years. While the long-term survival supports the continued implementation of DCD lungs, further studies are required to elucidate the mechanism of increased early mortal