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Lung Transplantation and Utilisation Following Donation after Circulatory Death (DCD) in the UK

Lookup NU author(s): Gillian Hardman, Professor Andrew Fisher, Professor John Dark

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Abstract

Copyright © 2020. Published by Elsevier Inc.PURPOSE: The number of potential donors after circulatory death (DCD) in the UK is increasing. DCD lung transplantation commenced in the UK in 2002 and is performed in 5 UK lung transplant centres. The aim of this study is to review the UK experience in lung utilisation and transplantation in DCD lung transplant. METHODS: Data on all adult lung offers (where at least 1 solid organ was donated) and transplants performed in the UK, between December 2002 and December 2018 were obtained from the UK Donor and UK Transplant Registries. Data were grouped by donor type, DCD or DBD. Donor and recipient characteristics and outcomes were compared between groups using the Wilcoxon, Chi-squared or log-rank tests as appropriate. RESULTS: There were 10993 organ donors who had lungs offered during the analysis period, of which 2095 (19%) were DCD. A total of 2571 adult lung transplants were performed, 316 (12%) of which were DCD. Both the number of potential lung DCD donors and the number of DCD lung transplants have increased over time. The proportion of DCD lung transplants in the UK has increased from 9% in 2008 to 21% in 2018. Utilisation for DCD lung offers is 15%, ranging from 10-17% each year. Utilisation for DBD donors during the period of analysis was 25%. There was no significant difference in donor age. In univariate analysis, DCD had significantly longer ischaemic times (7.1 hours vs 5.6 hours p=<0.0001) and more male donors (p=0.0020). Ex-vivo lung perfusion was used in 5% of DCD transplants. There was no significant difference in recipient age or recipient diagnosis. There were more urgent and super-urgent recipients in the DCD group (2.8% vs 4% p=0.048). There was a significant difference in unadjusted short-term survival, with 30-day survival of 90% in the DCD group and 94% in the DBD (p=0.0079), and 90-day survival of 86.2% in the DCD group and 89% in the DBD group (p=0.0337). Survival at 1-, 3- and 5-years was comparable. CONCLUSION: The number of potential DCD lung donors and the number of DCD lung transplants in the UK have increased exponentially since 2002. DCD lung transplants now account for 21% of UK lung transplant activity. Previous analysis of the UK DCD experience had shown comparable early and 1-year outcomes. Further analysis is required to understand significant differences in early survival for DCD lung recipients in the UK.


Publication metadata

Author(s): Hardman G, Hogg R, Rushton S, Booth K, Fisher AJ, Dark JH

Publication type: Article

Publication status: Published

Journal: The Journal of Heart and Lung Transplantation

Year: 2020

Volume: 39

Issue: 4

Pages: S139-S139

Print publication date: 01/04/2020

Acceptance date: 02/04/2016

ISSN (print): 1053-2498

ISSN (electronic): 1557-3117

Publisher: Elsevier

URL: https://doi.org/10.1016/j.healun.2020.01.1054

DOI: 10.1016/j.healun.2020.01.1054

PubMed id: 32464889


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