Original Articles
Excellent Clinical Outcomes From a National Donation-After-Determination-of-Cardiac-Death Lung Transplant Collaborative

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Donation-after-Determination-of-Cardiac-Death (DDCD) donor lungs can potentially increase the pool of lungs available for Lung Transplantation (LTx). This paper presents the 5-year results for Maastricht category III DDCD LTx undertaken by the multicenter Australian National DDCD LTx Collaborative. The Collaborative was developed to facilitate interaction with the Australian Organ Donation Authority, standardization of definitions, guidelines, education and audit processes. Between 2006 and 2011 there were 174 actual DDCD category III donors (with an additional 37 potentially suitable donors who did not arrest in the mandated 90 min postwithdrawal window), of whom 71 donated lungs for 70 bilateral LTx and two single LTx. In 2010 this equated to an “extra” 28% of donors utilized for LTx. Withdrawal to pulmonary arterial flush was a mean of 35.2 ± 4.0 min (range 18–89). At 24 h, the incidence of grade 3 primary graft dysfunction was 8.5%[median PaO2/FiO2 ratio 315 (range 50–507)]. Overall the incidence of grade 3 chronic rejections was 5%. One- and 5-year actuarial survival was 97% and 90%, versus 90% and 61%, respectively, for 503 contemporaneous brain-dead donor lung transplants. Category III DDCD LTx therefore provides a significant, practical, additional quality source of transplantable lungs.

Key words:

Donation-after-determination-of-cardiac-death
lung transplantation

Abbreviations:

BOS
bronchiolitis obliterans syndrome
BP syst <50 mmHg
systolic blood pressure <50 mmHg
DDCD
donation-after-determination-of-cardiac-death
DDND
donation-after-determination-of-neurological-death
GIT
graft ischemic time
ICU
intensive care unit
LTx
lung transplantation
OR
operating room
PGD
primary graft dysfunction
WIT
warm ischemic time
WLST
withdrawal of life-sustaining therapy

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