Abstract
Background
The outcomes of lung transplantation (LT) recipients who received a graft from a brain-dead
donor after successful resuscitation from cardiac arrest (CA donors) have been poorly
described. This study compared the one-year survival of LT recipients depending on
the CA status of the donor.
Methods
This prospective observational single-centre study analysed all consecutive patients
who underwent LT at Bichat Claude Bernard Hospital, Paris, between January 2016 and
December 2020. All donors who experienced CA prior to organ donation, regardless of
rhythm or duration, were considered CA donors. The postoperative complications and
outcomes of LT recipients were analysed. The one-year survival was compared using
Kaplan-Meier curves and log-rank tests. Independent risk factors for one-year mortality
were assessed using multivariate analysis (p < 0.05 was considered significant). The
Paris North Hospitals Institutional Review Board approved the study.
Results
A total of 236 LT recipients were analysed and 66 (28%) received a graft from a CA
donor. The median durations of no/low flow were 4 [0–10]/20 [15–30] minutes, respectively.
Shockable and non-shockable rhythms were observed in 11 (17%) and 47 (72%) of the
CA donors, respectively. The characteristics of the grafts and early postoperative
complications were not different in the CA and non-CA groups. Receiving a graft from
a CA donor was not an independent risk factor for recipient one-year mortality.
Conclusion
Receiving a graft from a CA donor did not worsen the outcome of LT recipients. Acceptation
of these grafts must be systematically considered to increase the pool of available
grafts.
Keywords
Abbreviations:
AKI (acute kidney injury), BMI (body mass index), CA (cardiac arrest), COPD (chronic obstructive pulmonary disease), CPR (cardiopulmonary resuscitation), ECMO (extracorporeal membrane oxygenation), FFP (fresh frozen plasma), ICU (intensive care unit), ISHLT (international society of heart and lung transplantation), KDIGO (Kidney disease improving global outcome), LF (Low flow), LT (lung transplantation), MOF (multiorgan failure), MV (mechanical ventilation), NF (no flow), OR (odds ratio), PF (pulmonary fibrosis), PGD (primary graft dysfunction), RBC (red blood cell), RRT (renal replacement therapy), SOFA (Sepsis-related Organ Failure Assessment)To read this article in full you will need to make a payment
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References
- Strategies for making more organs available for transplantation.N Engl J Med. 2000; 343: 404-410
- A review of lung transplant donor acceptability criteria.J Heart Lung Transplant. 2003; 22: 1183-1200
- Advanced considerations in organ donors.J Thorac Dis. 2021; 13: 6528-6535
- Liberalization of donor criteria may expand the donor pool without adverse consequence in lung transplantation.J Heart Lung Transplant. 2000; 19: 1199-1204
- Extended criteria donor lungs and clinical outcome: results of an alternative allocation algorithm.J Heart Lung Transplant. 2013; 32: 1065-1072
- An underrecognized source of organ donors: patients with brain death after successfully resuscitated cardiac arrest.Intensive Care Med. 2008; 34: 132-137
- The rate of brain death and organ donation in patients resuscitated from cardiac arrest: a systematic review and meta-analysis.Intensive Care Med. 2016; 42: 1661-1671
- Prediction of Brain Death After Out-of-Hospital Cardiac Arrest: Development and Validation of the Brain Death After Cardiac Arrest Score.Chest. 2021; 160: 139-147
- Trends in Donation After Circulatory Death in Lung Transplantation in the United States: Impact Of Era.Transpl Int. 2022; 35: 10172
- Report of the ISHLT Working Group on Primary Lung Graft Dysfunction, part I: Definition and grading-A 2016 Consensus Group statement of the International Society for Heart and Lung Transplantation.J Heart Lung Transplant. 2017; 36: 1097-1103
- KDIGO clinical practice guidelines for acute kidney injury.Nephron Clin Pract. 2012; 120: c179-184
- Acute Kidney Injury After Lung Transplantation: Perioperative Risk Factors and Outcome.Transplant Proc. 2020; 52: 967-976
- Blood transfusion of the donor is associated with stage 3 primary graft dysfunction after lung transplantation.Clin Transplant. 2021; 26: e14407
- The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: 37th adult heart transplantation report—2020; focus on deceased donor characteristics.J Heart Lung Transplant. 2020; 39: 1003-1015
- The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: 37th adult heart transplantation report-2020; focus on deceased donor characteristics.J Heart Lung Transplant. 2020; 39: 1003-1015
- Are patients brain-dead after successful resuscitation from cardiac arrest suitable as organ donors? A systematic review.Resuscitation. 2010; 81: 1609-1614
- Use of donors who have suffered cardiopulmonary arrest and resuscitation in lung transplantation.Eur J Cardio-Thorac Surg. 2011; 39: 342-347
- Use of Lung Allografts from Brain-Dead Donors after Cardiopulmonary Arrest and Resuscitation.Am J Respir Crit Care Med. 2013; 188: 466-473
- Protective effects of ischemic preconditioning on lung ischemia reperfusion injury: an in-vivo rabbit study.Thorac Cardiovasc Surg. 1999; 47: 38-41
- Protective effects of ischemic preconditioning on donor lung in canine lung transplantation.Chest. 1998; 113: 1356-1359
- A systematic review and pooled analysis of CPR-associated cardiovascular and thoracic injuries.Resuscitation. 2014; 85: 724-731
- Institutional experience with extracorporeal membrane oxygenation in lung transplantation.Eur J Cardio-Thorac Surg. 2007; 31 (discussion 473-474): 468-473
- Bilateral lung transplantation on intraoperative extracorporeal membrane oxygenator: An observational study.J Thorac Cardiovasc Surg. 2020; 160: 320-327.e1
- The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: Thirty-eighth adult lung transplantation report - 2021; Focus on recipient characteristics.J Heart Lung Transplant. 2021; 40: 1060-1072
Article info
Publication history
Published online: February 03, 2023
Accepted:
January 27,
2023
Received in revised form:
January 3,
2023
Received:
October 6,
2022
Identification
Copyright
© 2023 Elsevier B.V. All rights reserved.
