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The impact of thoracoabdominal normothermic regional perfusion on early outcomes in donation after circulatory death lung transplantation

https://doi.org/10.1016/j.healun.2023.04.009Get rights and content

Thoracoabdominal normothermic regional perfusion has emerged as an alternative method to procure donation after circulatory death (DCD) hearts, but its impact on concomitantly procured lung allografts remains unclear. The United Network for Organ Sharing database identified 627 DCD donors whose hearts were procured (211 in situ perfused, 416 directly procured) between December 2019 to December 2022. Lung utilization rates were 14.9% (63/422) for in situ perfused donors and 13.8% (115/832) for directly procured donors (p = 0.80). Following transplantation, lung recipients from in situ perfused donors required numerically lower rates of extracorporeal membrane oxygenation (7.7% vs 17.0%, p = 0.26) and mechanical ventilation (34.6% vs 47.2%, p = 0.29) at 72 hours. Six-month post-transplant survival was similar between groups (85.7% vs 89.1%, p = 0.67). These results suggest that the use of thoracoabdominal normothermic regional perfusion in DCD heart procurement may not adversely impact recipients of concomitantly procured lung allografts.

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Materials and methods

The United Network for Organ Sharing (UNOS) database was used to identify 627 DCD donors whose hearts were procured between December 2019 to December 2022 (Figure S1). They were stratified by the heart procurement technique into in situ perfusion (n = 211) and direct procurement (n = 416) using the interval between death confirmation time and aortic cross-clamp time as previously described.1 Briefly, an interval ≤20 minutes was considered to represent direct procurement, while an interval >20

Results

Of the 422 available lungs from in situ perfused donors, 63 (14.9%) were transplanted; of the 832 available lungs from directly procured donors, 115 (13.8%) were transplanted (p = 0.80). Over the same period, the lung utilization rate of DCD donors <35 years old where the heart was not procured was 5.6%. In both groups, the most common reason for discard was poor organ quality, followed by refusal by all programs (Figure 1). Rates of discard after operating room evaluation or procurement were

Discussion

This represents one of the the first studies utilizing national data to examine the effect of DCD heart procurement strategy on concomitant lung procurement and transplantation. Our findings suggest firstly that during DCD heart procurement, in situ thoracoabdominal normothermic regional perfusion was associated with a similar utilization rate of lung allografts compared to direct procurement. Additionally, in-hospital outcomes and short-term survival of lung transplantation after in situ

Author contributions

JM, QC, and PC were involved in the study conceptualization and design. JM, QC, and JT conducted the data analysis and drafted the manuscript. All authors were involved in data interpretation, manuscript review, and critical revisions and final approval of the manuscript.

Disclosure Statement

Jad Malas and Qiudong Chen are both supported by grants from the National Institutes of Health for advanced heart disease research (T32HL116273). The remaining authors have no relevant financial disclosures.

This work was supported in part by Health Resources and Services Administration contract HHSH250-2019-00001C. The content is the responsibility of the authors alone and does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of

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