Ex Vivo Lung Perfusion in Donation after Cardiac and Brain Death Donation.

Background: Allografts from donation after circulatory death (DCD) or brain death donors may be evaluated by ex vivo lung perfusion (EVLP) to assess quality for transplantation. We sought to determine the association of donor type with transplantation outcomes at a national level.

Methods: The United Network for Organ Sharing database was queried for lung transplant recipients, which were stratified into: DCD EVLP, brain death EVLP, standard DCD and standard brain death, followed by an unadjusted analysis. 1:1 propensity matching based on donor and recipient characteristics was used to compare DCD v DCD EVLP, brain death v brain death EVLP and brain death v DCD EVLP. The cohorts were assessed with comparative statistics. Finally, static and portable EVLP were compared to determine independent association with increased mortality.

Results: The unadjusted DCD EVLP group had significantly higher incidence of post-operative morbidity and mortality. 3-year survival was significantly lower in the DCD EVLP group, 65.3% (p=0.026). Following matching, the EVLP groups had significantly higher morbidity, and in-hospital mortality (DCD EVLP v brain death), but mid-term survival was no longer significantly different. However, the DCD EVLP group had about ∼6% lower survival than the DCD group (p=0.05) and about ∼7% lower survival than the brain death group (p=0.12). Within the EVLP groups, static and portable EVLP were not independently associated with increased mortality.

Conclusions: Expansion of DCD EVLP allografts increases organ access, though providers should be aware of potential increases in complications and mortality as compared to DCD alone.