Use of Normothermic Regional Perfusion in Circulatory Death Donors for Lung Transplantation in the United States

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation Pub Date : 2025-03-19 DOI:10.1111/ctr.70135

Jonathan E. Williams, John M. Trahanas, Jacob A. Klapper, Caitlin Demarest, Kiran H. Lagisetty, Andrew C. Chang, Dennis M. Lyu, David D. Odell, Matthew D. Bacchetta, Aaron M. Williams

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引用次数: 0

Abstract

Introduction

Use of normothermic regional perfusion (NRP) to recover donation after circulatory death (DCD) organs demonstrates increased heart utilization with favorable outcomes. Conversely, DCD lung allograft use when NRP was employed remains controversial. This is a contemporary analysis of DCD lung recipient outcomes in which NRP was used.

Methods

Utilizing the STAR-OPTN database, all adult DCD lung recipients in the United States between January 1, 2020, and June 30, 2024 were identified. NRP use was defined if the time between donor death and aortic clamp time was greater than 30 min. Recipient outcomes, including 30-, 60-, and 90-day mortality, grade-3 primary graft dysfunction (PGD), and postoperative length of stay were compared using multivariable logistic regression controlling for donor and recipient covariates. Survival analysis was performed using Cox proportional hazard modeling.

Results

Of 987 DCD lung transplants, 92 (9.4%) utilized NRP. There were no differences in recipient characteristics between direct recovery and NRP cohorts. No difference in 30-, 60-, or 90-day mortality, grade-3 PGD, or length of stay was found between cohorts. 12-month survival was equivalent.

Conclusions

Outcomes between NRP lung recipients were equivalent to DCD direct recovery recipients. Thus, donor lungs may be considered for transplantation following NRP donation procedures.

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在美国循环死亡供体中使用常温区域灌注进行肺移植

使用常温区域灌注（NRP）来恢复循环性死亡（DCD）器官捐献后的心脏利用率增加，结果良好。相反，当采用NRP时，DCD肺同种异体移植仍然存在争议。这是一项使用NRP的DCD肺受体结果的当代分析。方法利用STAR-OPTN数据库，对2020年1月1日至2024年6月30日期间美国所有成人DCD肺受体进行识别。如果供体死亡和主动脉夹夹时间之间的时间大于30分钟，则定义使用NRP。受体结局，包括30天、60天和90天死亡率、3级原发性移植物功能障碍（PGD）和术后住院时间，使用控制供体和受体共变量的多变量logistic回归进行比较。采用Cox比例风险模型进行生存分析。结果987例DCD肺移植中，92例（9.4%）采用NRP。直接恢复组和NRP组在受者特征上没有差异。在30天、60天或90天的死亡率、3级PGD或住院时间方面，在队列之间没有发现差异。12个月生存期相等。结论NRP肺受者与DCD直接恢复受者的预后相当。因此，可以考虑按照NRP捐赠程序进行供体肺移植。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.