Alexander Ryan Berg BS , Aravind Krishnan MD , Elbert Ekang Heng MD , Danielle Maria Mullis BS , Nataly Montano Vargas BS , Alyssa Garrison MS , Daniel Idris Zamora Alnasir BS , Amit Bangha MD , Gundeep Dhillon MD , Brandon Guenthart MD , Y. Joseph Woo MD , John MacArthur MD
{"title":"循环死亡后捐赠肺缩小单肺和双肺移植之间的生存差距：一项倾向匹配分析","authors":"Alexander Ryan Berg BS , Aravind Krishnan MD , Elbert Ekang Heng MD , Danielle Maria Mullis BS , Nataly Montano Vargas BS , Alyssa Garrison MS , Daniel Idris Zamora Alnasir BS , Amit Bangha MD , Gundeep Dhillon MD , Brandon Guenthart MD , Y. Joseph Woo MD , John MacArthur MD","doi":"10.1016/j.xjtc.2025.07.017","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><div>Single-lung transplantation (SLT) traditionally has inferior survival compared with bilateral-lung transplantation (BLT), raising concerns regarding its use. However, with the advent of donation after circulatory death (DCD), contemporary outcomes warrant reassessment. This study evaluates survival outcomes after SLT and BLT in the modern era, focusing specifically on the impact of DCD.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort analysis of adult lung transplants performed from 2018 to 2024 using the United Network for Organ Sharing database. Propensity score matching was applied to balance recipient and donor characteristics between SLT and BLT cohorts, followed by Kaplan-Meier and multivariable Cox regression analyses.</div></div><div><h3>Results</h3><div>Among 17,802 lung transplants (3747 SLT and 14,055 BLT), propensity matching yielded 3528 matched pairs. SLT recipients had significantly inferior long-term survival compared with BLT (adjusted hazard ratio [aHR], 1.35; 95% confidence interval [CI], 1.22-1.51; <em>P</em> < .001). However, when evaluating only DCD recipients, no significant survival differences emerged between SLT and BLT (aHR, 1.03; 95% CI, 0.68-1.5; <em>P</em> = .886). Notably, DCD SLT recipients demonstrated significantly better survival compared with donation after brain death SLT recipients (aHR, 1.48; 95% CI, 1.0–2.1; <em>P</em> = .03), despite higher rates of early graft dysfunction.</div></div><div><h3>Conclusions</h3><div>Although BLT is generally associated with superior survival outcomes compared with SLT, our contemporary analysis found that DCD SLT outcomes were comparable with DCD BLT and more favorable than donation after brain death SLT. These findings suggest that DCD lungs may be a viable option for single lung transplantation and highlight the potential role of DCD in expanding the donor pool. Further research is warranted to better understand long-term outcomes and optimize recipient selection for DCD SLT.</div></div>","PeriodicalId":53413,"journal":{"name":"JTCVS Techniques","volume":"33 ","pages":"Pages 294-305"},"PeriodicalIF":1.9000,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Donation-after-circulatory-death lungs narrow the survival gap between single- and bilateral-lung transplants: A propensity-matched analysis\",\"authors\":\"Alexander Ryan Berg BS , Aravind Krishnan MD , Elbert Ekang Heng MD , Danielle Maria Mullis BS , Nataly Montano Vargas BS , Alyssa Garrison MS , Daniel Idris Zamora Alnasir BS , Amit Bangha MD , Gundeep Dhillon MD , Brandon Guenthart MD , Y. Joseph Woo MD , John MacArthur MD\",\"doi\":\"10.1016/j.xjtc.2025.07.017\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objective</h3><div>Single-lung transplantation (SLT) traditionally has inferior survival compared with bilateral-lung transplantation (BLT), raising concerns regarding its use. However, with the advent of donation after circulatory death (DCD), contemporary outcomes warrant reassessment. This study evaluates survival outcomes after SLT and BLT in the modern era, focusing specifically on the impact of DCD.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort analysis of adult lung transplants performed from 2018 to 2024 using the United Network for Organ Sharing database. Propensity score matching was applied to balance recipient and donor characteristics between SLT and BLT cohorts, followed by Kaplan-Meier and multivariable Cox regression analyses.</div></div><div><h3>Results</h3><div>Among 17,802 lung transplants (3747 SLT and 14,055 BLT), propensity matching yielded 3528 matched pairs. SLT recipients had significantly inferior long-term survival compared with BLT (adjusted hazard ratio [aHR], 1.35; 95% confidence interval [CI], 1.22-1.51; <em>P</em> < .001). However, when evaluating only DCD recipients, no significant survival differences emerged between SLT and BLT (aHR, 1.03; 95% CI, 0.68-1.5; <em>P</em> = .886). Notably, DCD SLT recipients demonstrated significantly better survival compared with donation after brain death SLT recipients (aHR, 1.48; 95% CI, 1.0–2.1; <em>P</em> = .03), despite higher rates of early graft dysfunction.</div></div><div><h3>Conclusions</h3><div>Although BLT is generally associated with superior survival outcomes compared with SLT, our contemporary analysis found that DCD SLT outcomes were comparable with DCD BLT and more favorable than donation after brain death SLT. These findings suggest that DCD lungs may be a viable option for single lung transplantation and highlight the potential role of DCD in expanding the donor pool. Further research is warranted to better understand long-term outcomes and optimize recipient selection for DCD SLT.</div></div>\",\"PeriodicalId\":53413,\"journal\":{\"name\":\"JTCVS Techniques\",\"volume\":\"33 \",\"pages\":\"Pages 294-305\"},\"PeriodicalIF\":1.9000,\"publicationDate\":\"2025-10-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"JTCVS Techniques\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S266625072500330X\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"JTCVS Techniques","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S266625072500330X","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
摘要
目的单肺移植（SLT）的生存率传统上低于双肺移植（BLT），这引起了人们对其应用的关注。然而，随着循环性死亡（DCD）后捐赠的出现，当代的结果需要重新评估。本研究评估了现代SLT和BLT后的生存结果，特别关注了DCD的影响。方法利用美国器官共享网络数据库，对2018年至2024年进行的成人肺移植进行回顾性队列分析。使用倾向评分匹配来平衡SLT和BLT队列之间的受者和供者特征，然后进行Kaplan-Meier和多变量Cox回归分析。结果在17,802例肺移植中（SLT 3747例，BLT 14055例），倾向匹配得到3528对匹配。SLT接受者的长期生存率明显低于BLT（校正风险比[aHR]， 1.35； 95%可信区间[CI]， 1.22-1.51; P < .001）。然而，当仅评估DCD接受者时，SLT和BLT之间没有显着的生存差异（aHR, 1.03; 95% CI, 0.68-1.5; P = 0.886）。值得注意的是，尽管早期移植物功能障碍的发生率较高，但DCD SLT受者与脑死亡SLT受者相比，在脑死亡SLT受者中表现出明显更好的生存率（aHR, 1.48; 95% CI, 1.0-2.1; P = 0.03）。结论：尽管与SLT相比，BLT通常与更好的生存结果相关，但我们的当代分析发现，DCD SLT的结果与DCD BLT相当，并且比脑死亡SLT后的捐赠更有利。这些发现表明，DCD肺可能是单肺移植的可行选择，并强调了DCD在扩大供体池方面的潜在作用。为了更好地了解DCD SLT的长期疗效和优化受体选择，有必要进行进一步的研究。
Donation-after-circulatory-death lungs narrow the survival gap between single- and bilateral-lung transplants: A propensity-matched analysis
Objective
Single-lung transplantation (SLT) traditionally has inferior survival compared with bilateral-lung transplantation (BLT), raising concerns regarding its use. However, with the advent of donation after circulatory death (DCD), contemporary outcomes warrant reassessment. This study evaluates survival outcomes after SLT and BLT in the modern era, focusing specifically on the impact of DCD.
Methods
We conducted a retrospective cohort analysis of adult lung transplants performed from 2018 to 2024 using the United Network for Organ Sharing database. Propensity score matching was applied to balance recipient and donor characteristics between SLT and BLT cohorts, followed by Kaplan-Meier and multivariable Cox regression analyses.
Results
Among 17,802 lung transplants (3747 SLT and 14,055 BLT), propensity matching yielded 3528 matched pairs. SLT recipients had significantly inferior long-term survival compared with BLT (adjusted hazard ratio [aHR], 1.35; 95% confidence interval [CI], 1.22-1.51; P < .001). However, when evaluating only DCD recipients, no significant survival differences emerged between SLT and BLT (aHR, 1.03; 95% CI, 0.68-1.5; P = .886). Notably, DCD SLT recipients demonstrated significantly better survival compared with donation after brain death SLT recipients (aHR, 1.48; 95% CI, 1.0–2.1; P = .03), despite higher rates of early graft dysfunction.
Conclusions
Although BLT is generally associated with superior survival outcomes compared with SLT, our contemporary analysis found that DCD SLT outcomes were comparable with DCD BLT and more favorable than donation after brain death SLT. These findings suggest that DCD lungs may be a viable option for single lung transplantation and highlight the potential role of DCD in expanding the donor pool. Further research is warranted to better understand long-term outcomes and optimize recipient selection for DCD SLT.
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