Controlled donation after circulatory death lung transplantation: Results of the French protocol including in situ abdominal normothermic regional perfusion and ex vivo lung perfusion

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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 minutes [2-166]. The median duration from circulatory arrest to pulmonary flush was 62 minutes [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 minutes [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.

Section snippets

Study design

We set up a retrospective study of a prospectively maintained administrative database including all donors considered for cDCD LT from the beginning of the program in May 2016 to November 2021. The primary objective was to report what became of accepted lung grafts throughout the DCD protocol. Secondary objectives were to assess morbidity and mortality following DCD LT in France.

Ethical aspects

The study protocol was established by the LT group of the Société Française de Chirurgie Thoracique et Cardio

Unsuccessful procedures

Over the study period, 100 cDCD lung grafts from 14 different hospitals were accepted by 6 LT teams. Twenty-four lung procurement procedures from cDCD donors did not result in LT due to agonal phase timeouts (n = 3), failure of NRP cannulation (n = 5), or poor in situ evaluation of the lungs with total consolidation of more than 1 lobe (n = 2). A further 14 EVLP did not meet the criteria for transplantation, resulting in an EVLP conversion rate of 84% and a cDCD transplantation rate of 76%.

Study group

The

Main results reminder

cDCD LT according to the French protocol, including abdominal NRP and EVLP, is a safe and promising protocol. we found an EVLP conversion rate of 84% for retrieved lungs, and a cDCD transplantation rate of 76%. Early postoperative outcomes include PGD3 in 9% of the cases, and 1-year survival of 93.4%.

French protocol

The lack of a dedicated protocol for cDCD procedures is one of the main reasons why, despite good results reported worldwide with Maastricht category 3 DCD donors, there are disparities in their

Conclusions

The French protocol of cDCD LT including abdominal NRP and EVLP is associated with very encouraging results regarding cDCD-to-LT conversion, EVLP conversion, PGD3 rate, and 1-year survival rate, offering an interesting way to increase the pool of grafts and French lung transplantation activity.

Disclosure statement

The authors have no conflicts of interest to declare.

References (23)

  • A Palleschi et al.

    Lung transplantation from donation after controlled cardiocirculatory death. Systematic review and meta-analysis

    Transplant Rev (Orlando)

    (2020)
  • JD Hardy et al.

    LUNG Homotransplantation In Man

    JAMA

    (1963)
  • RB. Love

    First successful lung transplantation using a nonheart-beating donor

    J Heart Lung Transplant

    (1995)
  • S Steen et al.

    Transplantation of lungs from a non-heart-beating donor

    Lancet

    (2001)
  • D Van Raemdonck et al.

    Donation after circulatory death in lung transplantation: five-year follow-up from ISHLT Registry

    J Heart Lung Transplant

    (2019)
  • M Cypel et al.

    International society for heart and lung transplantation donation after circulatory death registry report

    J Heart Lung Transplant

    (2015)
  • M Cypel et al.

    Lung transplantation using controlled donation after circulatory death donors: trials and tribulations

    J Heart Lung Transplant

    (2016)
  • MA Villavicencio et al.

    Lung transplantation from donation after circulatory death: United States and single-center experience

    Ann Thorac Surg

    (2018)
  • ME Erasmus et al.

    Lung transplantation from nonheparinized category III non-heart-beating donors. A single-centre report

    Transplantation

    (2010)
  • Arrêté du 1er août 2014 modifiant l’arrêté du 2 août 2005 fixant la liste des organes pour lesquels le prélèvement sur...
  • C Antoine et al.

    How France launched its donation after cardiac death program

    Ann Fr Anesth Reanim

    (2014)
  • Cited by (2)

    View full text