Outcome after Lung Transplantation Is Comparable between DCD and DBD

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• 作者：D. Van Raemdonck¹ ; B. Vanaudenaerde² ; S. Verleden² ; D. Ruttens² ; R. Vos³ ; L. Dupont³ ; M. Delcroix³ ; W. Wuyts³ ; J. Yserbyt³ ; A. Neyrinck⁴ ; W. Coosemans¹ ; H. Decaluwé ; ¹ ; P. De Leyn¹ ; P. Nafteux¹ ; H. Van Veer¹ ; G.M. Verleden³
• 刊名：The Journal of Heart and Lung Transplantation
• 出版年：2013
• 出版时间：April, 2013
• 年：2013
• 卷：32
• 期：4_supp_S
• 页码：S122
• 全文大小：96 K

文摘

| Figures/TablesFigures/Tables

Purpose

Large institutional series comparing long-term outcome after LTx between donors after circulatory death (DCD) vs brain death (DBD) are scarce.

Methods and Materials

Between 01/01/2007-01/08/2012, 307 LTx were performed (266DBD/41DCD). Donor selection, lung preservation, operative technique, and post-LTx management were identical. Prospective database was reviewed for D/R demographics, ischemic times, and outcome.

Results

No significant differences were found in D/R characteristics. However, DBD suffered more from traumatic (33 % vs 20 % ) and less from hypoxic (11 % vs 24 % ) injury; p<0.001. DCD were located in 2 OPO-states only (85 % -15 % ); p<0.01. Agonal phase was 13¡À8 min followed by 12¡À4 min warm ischemia. Total ischemic times (257¡À68 vs 295¡À56 min for 1st lung and 407¡À86 vs 465¡À101 min for 2^nd lung; p<0.01) and bypass time (228¡À105 vs 348¡À271 min; p<0.05) were shorter in DBD vs DCD, respectively. Hospital mortality (3 % vs 5 % NS), 1-, 3-, and 5-year survival (92 % , 85 % , 84 % vs 93 % , 74 % , 74 % NS), and freedom from BOS (95 % , 88 % , 83 % vs 90 % , 81 % , 65 % NS) were comparable.

Conclusions

DCD-LTx increased transplant volume by 15.4 % with comparable outcome to DBD-recipients. The additional 25¡À9min injurious delay prior to cold preservation does not seem to be detrimental.

Characteristic	DBD (n=266)	DCD (n=41)	p-value
D-age (yrs)	45¡À14	47¡À13	N.S.
D-sex (M/F) %	49/51	61/39	N.S
D-height (cm)	173¡À10	174¡À8	N.S
D-weight (kg)	74¡À14	74¡À11	N.S.
D-BG (O/A/B/AB) %	54/39/6/1	44/41/15/0	N.S
D-CMV (-/+) %	58/42	51/49	N.S
D-ventilation (hrs)	87¡À116	97¡À70	N.S
D-PaO2/FiO2 (mm Hg)	451¡À93	443¡À83	N.S
R-age (yrs)	50¡À15	50¡À13	N.S
R-sex (M/F) %	48/52	61/39	N.S
R-height (cm)	167¡À10	170¡À8	N.S
R-weight (kg)	63¡À26	65¡À14	N.S
R-BG (O/A/B/AB) %	47/42/19/2	41/44/15/0	N.S
R-CMV (-/+) %	55/45	63/37	N.S
R-waiting time (ds)	243¡À211	222¡À234	N.S.
Emphysema ( % )	52	46	N.S.
Pulmonary Fibrosis ( % )	22	27	N.S.
Infectious Disease ( % )	14	15	N.S.
Other Disease ( % )	12	12	N.S.
LTx type (SSL/SL) %	90/10	98/2	N.S.
CP-support ( % )	24	12	0.04