title: Use of lung allografts from brain-dead donors after cardiopulmonary arrest and resuscitation.
abstract: BACKGROUND
  Patients who progress to brain death after resuscitation from cardiac arrest have been hypothesized to represent an underused source of potential organ donors; however, there is a paucity of data regarding the viability of lung allografts after a period of cardiac arrest in the donor.
  
  
  OBJECTIVE
  To analyze postoperative complications and survival after lung transplant from brain-dead donors resuscitated after cardiac arrest.
  
  
  METHODS
  The United Network for Organ Sharing database records donors with cardiac arrest occurring after brain death. Adult recipients of lung allografts from these arrest/resuscitation donors between 2005 and 2011 were compared with nonarrest donors. Propensity score matching was used to reduce the effect of confounding. Postoperative complications and overall survival were assessed using McNemar's test for correlated binary proportions and Kaplan-Meier methods.
  
  
  RESULTS
  A total of 479 lung transplant recipients from arrest/resuscitation donors were 1:1 propensity matched from a cohort of 9,076 control subjects. Baseline characteristics in the 1:1-matched cohort were balanced. There was no significant difference in perioperative mortality, airway dehiscence, dialysis requirement, postoperative length of stay (P ≥ 0.38 for all), or overall survival (P = 0.52). A subanalysis of the donor arrest group demonstrated similar survival when stratified by resuscitation time quartile (P = 0.38).
  
  
  CONCLUSIONS
  There is no evidence of inferior outcomes after lung transplant from brain-dead donors who have had a period of cardiac arrest provided that good lung function is preserved and the donor is otherwise deemed acceptable for transplantation. Potential expansion of the donor pool to include cardiac arrest as the cause of brain death requires further study.
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA. anthony.castleberry@duke.edu
authors.forename: Anthony W
authors.initials: AW
authors.lastname: Castleberry
authors.forename: Mathias
authors.initials: M
authors.lastname: Worni
authors.forename: Asishana A
authors.initials: AA
authors.lastname: Osho
authors.forename: Laurie D
authors.initials: LD
authors.lastname: Snyder
authors.forename: Scott M
authors.initials: SM
authors.lastname: Palmer
authors.forename: Ricardo
authors.initials: R
authors.lastname: Pietrobon
authors.forename: R Duane
authors.initials: RD
authors.lastname: Davis
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Hartwig
mesh_terms: D000328:Adult; D001926:Brain Death; D016887:Cardiopulmonary Resuscitation; D005260:Female; D006323:Heart Arrest / Q000401:mortality*; D006801:Humans; D016040:Lung Transplantation; D008297:Male; D057216:Propensity Score; D014019:Tissue Donors; D014184:Transplantation, Homologous; D055815:Young Adult