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

71 

Abstract Submission 

J. Sam Meyer (1), Oliver Jawitz (2), Yury Peysakhovich (3), Dan Aravot (4), Matthew Hartwig (5), Yaron Barac (6)

(1) N/A, N/A, (2) Duke University Hospital, Durham, NC, (3) Yury Peysakhovich, Petah Tikwa, Israel, (4) Rabin Medical Center, Petach Tikva, Israel, (5) Duke Hospital, Durham, North Carolina, (6) Duke medical center, Petach Tikva, Israel

J. Sam Meyer    -  Contact Me
N/A

Oliver Jawitz    -  Contact Me
Duke University Hospital

Yury Peysakhovich    -  Contact Me
Yury Peysakhovich

Dan Aravot    -  Contact Me
Rabin Medical Center

*Matthew Hartwig    -  Contact Me
Duke Hospital

Yaron Barac    -  Contact Me
Duke medical center

J. Sam Meyer    -  Contact Me
N/A

Objective
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.

End Stage Lung Disease and Lung Transplantation