title: Lungs from donation after circulatory death donors: an alternative source to brain-dead donors? Midterm results at a single institution.
abstract: OBJECTIVE
  Donor organ shortage remains to be the major limitation in lung transplantation, and donation after circulatory death (DCD) might represent one way to alleviate this problem. DCD was introduced to our institution in 2007 and has been a part of our clinical routine since then. Here, we present the mid-term results of lung transplantation from DCD in a single institution and compare the outcomes with the lung recipient cohort receiving lungs from donation after brain death (DBD).
  
  
  METHODS
  Since initiation of the DCD programme in March 2007, of the 157 lung transplantations performed, 26 (16.5%) were retrieved from DCD donors, with 25 double- and 1 single-lung transplants being performed. Results were compared with standard DBD transplantations. Analyses included, amongst others, donor characteristics, survival, prevalence of primary graft dysfunction, acute rejection, lung function tests during follow-up, onset of bronchiolitis obliterans syndrome (BOS) as well as duration of mechanical ventilation, hospital and intensive care unit length of stay.
  
  
  RESULTS
  While there was no significant difference between lung function, BOS and survival between the two groups, lungs from DCD donors had a higher PaO(2) (median; interquartile range) 498.3 (451.5; 525) vs. DBD 442.5 (371.25; 502) kPa before retrieval (P = 0.009). There was also a longer total ischaemic time in the DCD vs. DBD group: 320 min (298.75; 393.25) vs. 285.5 min (240; 373) (P = 0.025). All other parameters were comparable.
  
  
  CONCLUSIONS
  Medium-term results after lung transplantation with organs procured after circulatory death are comparable with those obtained after standard lung transplantation. Therefore, DCD could be used to significantly increase the donor pool.
authors.affiliation: Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, London, UK. b.zych@rbht.nhs.uk
authors.forename: Bartlomiej
authors.initials: B
authors.lastname: Zych
authors.forename: Aron-Frederik
authors.initials: AF
authors.lastname: Popov
authors.forename: Mohamed
authors.initials: M
authors.lastname: Amrani
authors.forename: Toufan
authors.initials: T
authors.lastname: Bahrami
authors.forename: Karen Christina
authors.initials: KC
authors.lastname: Redmond
authors.forename: Heike
authors.initials: H
authors.lastname: Krueger
authors.forename: Martin
authors.initials: M
authors.lastname: Carby
authors.forename: André Ruediger
authors.initials: AR
authors.lastname: Simon
mesh_terms: D000328:Adult; D001926:Brain Death; D015331:Cohort Studies; D003643:Death; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D016040:Lung Transplantation / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D055031:Primary Graft Dysfunction / Q000453:epidemiology / Q000503:physiopathology*; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D015996:Survival Rate; D013997:Time Factors; D014019:Tissue Donors / Q000600:supply & distribution*; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome; D006113:United Kingdom