Early national trends of lung allograft use during donation after circulatory death heart procurement in the United States

Kukbin Choi; Cristiano Spadaccio; Rafaela V P Ribeiro; Blake T Langlais; Mauricio A Villavicencio; Kelly Pennington; Philip J Spencer; Richard C Daly; Jorge Mallea; Shaf Keshavjee; Marcelo Cypel; Sahar A Saddoughi

doi:10.1016/j.xjon.2023.08.014

Early national trends of lung allograft use during donation after circulatory death heart procurement in the United States

JTCVS Open. 2023 Sep 4:16:1020-1028. doi: 10.1016/j.xjon.2023.08.014. eCollection 2023 Dec.

Affiliations

¹ Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn.
² Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, Ariz.
³ Division of Pulmonary & Critical Care, Department of Medicine, Mayo Clinic, Rochester, Minn.
⁴ Division of Pulmonary, Allergy and Sleep Medicine, Department of Medicine, Mayo Clinic, Jacksonville, Fla.
⁵ Department of Thoracic Surgery, Toronto General Hospital, Toronto, Ontario, Canada.
⁶ Division of Thoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minn.

Abstract

Objective: Innovative technology such as normothermic regional perfusion and the Organ Care System has expanded donation after circulatory death heart transplantation. We wanted to investigate the impact of donation after circulatory death heart procurement in concurrent lung donation and implantation at a national level.

Methods: We reviewed the United Network for Organ Sharing database for heart donation between December 2019 and March 2022. Donation after circulatory death donors were separated from donation after brain death donors and further categorized based on concomitant organ procurement of lung and heart, or heart only.

Results: A total of 8802 heart procurements consisted of 332 donation after circulatory death donors and 8470 donation after brain death donors. Concomitant lung procurement was lower among donation after circulatory death donors (19.3%) than in donation after brain death donors (38.0%, P < .001). The transplant rate of lungs in the setting of concomitant procurement is 13.6% in donation after circulatory death, whereas it is 38% in donation after brain death (P < .001). Of the 121 lungs from 64 donation after circulatory death donors, 22 lungs were retrieved but discarded (32.2%). Normothermic regional perfusion was performed in 37.3% of donation after circulatory death donors, and there was no difference in lung use between normothermic regional perfusion versus direct procurement and perfusion (20.2% and 18.8%). There was also no difference in 1-year survival between normothermic regional perfusion and direct procurement and perfusion.

Conclusions: Although national use of donation after circulatory death hearts has increased, donation after circulatory death lungs has remained at a steady state. The implantation of lungs after concurrent procurement with the heart remains low, whereas transplantation of donation after circulatory death hearts is greater than 90%. The use of normothermic regional perfusion lungs has been controversial, and we report comparable 1-year outcomes to standard donation after circulatory death lungs. Further studies are warranted to investigate the underlying mechanisms of normothermic regional perfusion on lung function.

Keywords: donation after circulatory death; lung transplantation; normothermic regional perfusion; organ donation.