Investigating the impact of donor brain death duration on outcomes after lung transplant.

Abstract

Background: Donor brain death induces haemodynamic and inflammatory changes that may influence organ quality and post-transplant outcomes. The impact of donor brain death duration on outcomes after lung transplantation remains uncertain.

Methods: We conducted a retrospective cohort study using the United Network for Organ Sharing database, including adult first-time lung transplant recipients from 2010 to December 2024. Donor brain death duration was defined as the interval between confirmation of donor brain death and donor cross-clamp. Missing data were addressed using multiple imputation. Multivariable Cox and logistic regression models assessed associations between brain death duration and post-transplant outcomes. Continuous variables were modeled using restricted cubic splines to preserve non-linear relationships.

Results: About 31,178 patients were included. Median brain death duration was 49.8 hours (interquartile range 36.7-67.7). Longer brain death duration was independently associated with improved early outcomes, with a significant non-linear association with 90-day patient survival (p=0.004). A duration of 96 hours vs 24 hours was associated with improved 90-day patient survival (hazard ratio 0.73; 95% confidence interval 0.60-0.88). Similar associations were observed for 90-day graft survival. Longer duration was also associated with lower odds of 72-hour primary graft dysfunction (p=0.002) and 72-hour extracorporeal membrane oxygenation requirement (p<0.001). These associations were not sustained at 1 or 5 years.

Conclusion: A longer duration between donor brain death and retrieval was associated with improved early outcomes, including lower 90-day patient mortality, without adverse long-term outcomes. These findings suggest that prolonged brain death duration alone should not negatively influence donor lung utilization decisions.