Initial experience with lung donation after cardiocirculatory death in Canada.
BACKGROUND
Organ donation after cardiac death (DCD) has the potential to alleviate some of the shortage of suitable lungs for transplantation. Only limited data describe outcomes after DCD lung transplantation. This study describes the early and intermediate outcomes after DCD lung transplantation in Canada.


METHODS
Data were collected from donors and recipients involved in DCD lung transplantations between June 2006 and December 2008. Described are the lung DCD protocol, donor characteristics, and the occurrence of post-transplant events including primary graft dysfunction (PGD), bronchial complications, acute rejection (AR), bronchiolitis obliterans syndrome (BOS), and survival.


RESULTS
Successful multiorgan controlled DCD increased from 4 donors in 2006 to 26 in 2008. Utilization rates of lungs among DCD donors were 0% in 2006, 11% in 2007, and 27% in 2008. The lung transplant team evaluated 13 DCD donors on site, and lungs from 9 donors were ultimately used for 10 recipients. The 30-day mortality was 0%. Severe PGD requiring extracorporeal membrane oxygenation occurred in 1 patient. Median intensive care unit stay was 3.5 days (range, 2-21 days). Hospital stay was 25 days (range, 9-47 days). AR occurred in 2 patients. No early BOS has developed. Nine (90%) patients are alive at a median of 270 days (range, 47-798 days) with good performance status and lung function. One patient died of sepsis 17 months after transplantation.


CONCLUSIONS
DCD has steadily increased in Canada since 2006. The use of controlled DCD lungs for transplantation is associated with very acceptable early and intermediate clinical outcomes.
Cypel
Marcelo
M
The Toronto Lung Transplant Program, University of Toronto, Toronto, Ontario, Canada.
Sato
Masaaki
M
Yildirim
Erkan
E
Karolak
Wojtek
W
Chen
Fengshi
F
Yeung
Jonathan
J
Boasquevisque
Carlos
C
Leist
Victoria
V
Singer
Lianne G
LG
Yasufuku
Kazuhiro
K
Deperrot
Marc
M
Waddell
Thomas K
TK
Keshavjee
Shaf
S
Pierre
Andrew
A
D000293:Adolescent; D000328:Adult; D002170:Canada; D003643:Death; D005260:Female; D006323:Heart Arrest; D006801:Humans; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D014019:Tissue Donors; D020858:Tissue and Organ Harvesting; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome