尽管移植后的结果相似，外科医生仍担心使用DCD肺：一项20年的UNOS回顾性分析

JHLT Open Pub Date : 2025-02-01 DOI:10.1016/j.jhlto.2024.100185

J. Sam Meyer MSc , Oliver K. Jawitz MD, MHS , Yury Peysakhovich MD , Dan Aravot MD , Matthew G. Hartwig MD, MHS , Yaron D. Barac MD, PhD

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However, expansion of DCD lung transplants requires a comparison of these indicators to DBD donors for application of similar parameters to increase the rate of DCD lung recovery to ensure that viable DCD organs are not discarded due to overly stringent donor and organ requirements.</div></div><div><h3>Methods</h3><div>We performed a retrospective analysis of United Network for Organs Sharing (UNOS) Organ Procurement and Transplantation Network/UNOS STAR (Standard Analysis and Research) database. Donors who donated ≥1 organ from 10/1999–01/2019 were extracted and stratified according to DBD and DCD status. 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A multivariable regression analysis showed that the odds of a potential DCD donating lungs is 75% lower than (<em>P</em> < 0.001) that of a potential DBD when the cause of death (COD) is stroke, head trauma (44% lower <em>P</em> = 0.076), CNS tumor (22% lower <em>P</em> = 0.174) or MVA (69% lower <em>P</em> = 0.183). A history of diabetes for over 10 years was strongly associated with non-use for DCD lungs (OR, 0.87, <em>P</em> = 0.71), whereas an under 10-year history was associated with increased use (OR 2.33, <em>P</em> = 0.008, OR 1.07 <em>P</em> = 0.819).</div><div>Lungs from donors ages 40–49 are more likely to be procured than those <30 or >50 in both DBD and DCD. However, likelihood of procurement is 1.84 [95% 1.42, 2.38, <em>p</em> < 0.001] times higher in 40–49-year-old vs. <30-year-old donors when comparing DBD vs. DCD, and 2.43 [95% 1.83, 3.22, <em>p</em> < 0.001] times higher than patients >50 in DBD vs DCD donors. 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引用次数: 0

摘要

目的：随着美国肺移植率的增长，等待移植的患者死亡率也在上升。虽然文献报道了DBD和DCD移植的相似生存结果，但研究应探讨DCD肺恢复方案的改进，以增加恢复的总数量。最近，Choi等人提出了指示最终肺恢复的供体变量1。然而，扩大DCD肺移植需要将这些指标与DBD供体进行比较，应用相似的参数来提高DCD肺的恢复率，以确保有活力的DCD器官不会因供体和器官要求过于严格而被丢弃。方法对美国器官共享网络（UNOS）器官获取与移植网络/UNOS STAR（标准分析与研究）数据库进行回顾性分析。选取1999年10月至2019年1月期间捐献器官≥1个器官的献血者，按DBD和DCD状态进行分层。比较潜在DCD和DBD肺供者的相关特征，并构建≥1个移植肺的多变量logistic回归模型，评估重要预测因素的独立影响。结果共纳入潜在肺供体179228例，其中DBD 162157例（捐献31486例，恢复率19.4%），DCD 17071例（捐献526例，恢复率3.1%）。DBD和DCD供者之间肺不使用的几率与血型、酒精使用、死亡原因、吸烟史、药物使用、死亡情况、种族、性别、高血压、癌症、年龄和肺pO2 （100% P/F比）显著相关(P <；0.001对于所有变量)。多变量回归分析显示，潜在的DCD捐献肺的几率比(P <；0.001)，当死亡原因（COD）为中风、头部外伤（P = 0.076降低44%）、中枢神经系统肿瘤（P = 0.174降低22%）或MVA （P = 0.183降低69%）时，潜在DBD的发生率降低。10年以上的糖尿病史与不使用DCD肺密切相关（OR, 0.87, P = 0.71），而10年以下的糖尿病史与使用DCD肺的增加相关（OR 2.33, P = 0.008, OR 1.07 P = 0.819）。在DBD和DCD中，年龄在40-49岁的捐赠者比年龄在30岁或50岁的捐赠者更有可能获得肺。然而，采购的可能性为1.84 [95% 1.42,2.38,p <；40 - 49岁的献血者与30岁的献血者相比，DBD和DCD分别高出0.001倍和2.43倍[95% 1.83,3.22,p <；0.001]是DBD和DCD供者的50倍。此外，在每个时代，获得DCD和DBD肺的几率持续提高[95% 1.46-2.57,p <；0.001]。DCD肺排斥与供体心肺功能较高相关。弃用DCD肺供者左室射血分数高于弃用DBD肺供者（DCD 56.9%±13.6 vs DBD 51.3%±17.3 P = <0.001）。肺PO2在100% O2时（DCD为189.4±121.3比DBD为150.0±106.2 P = <0.001）和P/F比高于350.00时（DCD为13.5%比DBD为7.7% P = <0.001）也发现了类似的不使用模式。结论：尽管文献报道了DCD和DBD器官的可比较生存率，但本研究强调了在评估DBD和DCD供体特征方面的差异。其他器官的获取过程中是否存在类似的差异，有待进一步研究。

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Surgeons are apprehensive to use DCD lungs despite similar post-transplant outcomes: A 20-year UNOS retrospective analysis

Purpose

As rates of lung transplants in the US grow, waitlist mortality increases. While the literature reports similar survival outcomes of DBD and DCD transplants, research should investigate improvements to DCD lung recovery protocols to increase the total number recovered. Recently, Choi et al. presented donor variables indicative of ultimate lung recovery¹. However, expansion of DCD lung transplants requires a comparison of these indicators to DBD donors for application of similar parameters to increase the rate of DCD lung recovery to ensure that viable DCD organs are not discarded due to overly stringent donor and organ requirements.

Methods

We performed a retrospective analysis of United Network for Organs Sharing (UNOS) Organ Procurement and Transplantation Network/UNOS STAR (Standard Analysis and Research) database. Donors who donated ≥1 organ from 10/1999–01/2019 were extracted and stratified according to DBD and DCD status. Associated characteristics of potential DCD and DBD lung donors were compared, and a multivariable logistic regression model with ≥1 transplanted lung was constructed to evaluate the independent effects of important predictors.

Results

Our data included 179,228 potential lung donors, 162,157 DBD (31,486 donated, 19.4% recovery) and 17,071 DCD (526 donated, 3.1% recovery). Odds of lung non-use between DBD and DCD donors were significantly associated with blood type, alcohol use, cause of death, smoking history, drug use, death circumstance, ethnicity, gender, hypertension, cancer, age, and lung pO2 on 100% P/F ratio (P < 0.001 for all variables). A multivariable regression analysis showed that the odds of a potential DCD donating lungs is 75% lower than (P < 0.001) that of a potential DBD when the cause of death (COD) is stroke, head trauma (44% lower P = 0.076), CNS tumor (22% lower P = 0.174) or MVA (69% lower P = 0.183). A history of diabetes for over 10 years was strongly associated with non-use for DCD lungs (OR, 0.87, P = 0.71), whereas an under 10-year history was associated with increased use (OR 2.33, P = 0.008, OR 1.07 P = 0.819).

Lungs from donors ages 40–49 are more likely to be procured than those <30 or >50 in both DBD and DCD. However, likelihood of procurement is 1.84 [95% 1.42, 2.38, p < 0.001] times higher in 40–49-year-old vs. <30-year-old donors when comparing DBD vs. DCD, and 2.43 [95% 1.83, 3.22, p < 0.001] times higher than patients >50 in DBD vs DCD donors. In addition, for each era, the odds for procuring DCD vs. DBD lungs consistently improved [95% 1.46–2.57, p < 0.001].

Rejected DCD lungs were associated with donors with higher cardiopulmonary function. Left ventricular ejection fractions in discarded DCD lung donors were higher than those of discarded DBD lung donors (DCD 56.9% ± 13.6 vs. DBD 51.3% ±17.3 P = <0.001). Similar non-use patterns were identified for lung PO₂ on 100% O₂ (DCD 189.4 ± 121.3 vs. DBD 150.0 ± 106.2 P = <0.001), and when the P/F ratio was above 350.00 (DCD 13.5% vs. DBD 7.7% P = <0.001).

Conclusion

Despite literature reporting comparable survival of DCD and DBD organs, this study highlights discrepancies in lung procurement practices that evaluate donor characteristics differently in DBD and DCD donors. Further study should investigate whether similar discrepancies exist in the procurement process of other organs.

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