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