Abstract
background
The French national protocol for controlled donation after circulatory determination
of death (cDCD) includes normothermic regional perfusion (NRP) in case of abdominal
organ procurement and additional ex-vivo lung perfusion (EVLP) before considering
lung transplantation (LT).
methods
We made a retrospective study of a prospective registry that included all donors considered
for cDCD LT from the beginning of the program in May 2016 to November 2021.
results
One hundred grafts from 14 donor hospitals were accepted by 6 LT centers. The median
duration of the agonal phase was 20 min [2-166]. The median duration from circulatory
arrest to pulmonary flush was 62 min [20-90]. Ten lung grafts were not retrieved due
to prolonged agonal phases (n=3), failure of NRP insertion (n=5), or poor in situ
evaluation (n=2). The remaining 90 lung grafts were all evaluated on EVLP, with a
conversion rate of 84% and a cDCD transplantation rate of 76%. The median total preservation
time was 707 min [543-1038]. Seventy-one bilateral LTs and 5 single LTs were performed
for chronic obstructive pulmonary disease (n= 29), pulmonary fibrosis (n=21), cystic
fibrosis (n=15), pulmonary hypertension (n=8), graft-versus-host disease (n=2), and
adenosquamous carcinoma (n=1). The rate of PGD3 was 9% [n=5]. The 1-year survival
rate was 93.4%.
conclusion
After initial acceptance, cDCD lung grafts led to LT in 76% of cases, with outcomes
similar to those already reported in the literature. The relative impacts of NRP and
EVLP on the outcome following cDCD LT should be assessed prospectively in the context
of comparative studies.
Keywords
Abbreviations:
controlled donation after circulatory determination of death (cDCD), normothermic regional perfusion (NRP), ex-vivo lung perfusion (EVLP), lung transplantation (LT), primary graft dysfunction (PGD), chronic obstructive pulmonary disease (COPD), idiopathic pulmonary fibrosis (IPF), cystic fibrosis (CF), pulmonary hypertension (PH), deceased brain deaths (DBDs), the International Society of Heart and Lung Transplantation (ISHLT), société Française de Chirurgie Thoracique et Cardio Vasculaire (SFCTCV), organ procurement organization (OPO), agence de la biomédecine (ABM), withdrawal of life-sustaining therapies (WLST), warm ischemic time (WIT), the inferior vena cava (IVC), the superior vena cava (SVC), extra corporeal membrane oxygenation (ECMO), cardio pulmonary bypass (CPB)To read this article in full you will need to make a payment
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