title: Donation After Circulatory Determination of Death Lung Transplantation for Pulmonary Arterial Hypertension: Passing the Toughest Test.
abstract: Lung transplantation (LTx) is a therapeutic option for severe pulmonary arterial hypertension (PAH) patients failing optimal medical therapy. The use of donation after circulatory determination of death (DCDD) donor lungs for PAH LTx has rarely been reported, primarily reflecting concerns that DCDD lungs represent extended criteria donors, at risk of morbidity and mortality. A retrospective study of all Alfred Hospital DCDD and DNDD (donation after neurologic determination of death) PAH LTx was undertaken. Protocolized fluid/inotrope/ventilator and extracorporeal membrane oxygenation (ECMO) strategies were utilized. Since our first DCDD LTx in 2006, 512 LTx have been performed. Of 31 PAH recipients, 11 received DCDD lungs (11% of DCDD LTx) and 20 received DNDD lungs (5% of DNDD LTx) (p = 0.04). Only one PAH patient died on the LTx waiting list. Peri-LTx ECMO was utilized in 3/11 (27%) DCDD and 6/20 (30%) DNDD PAH LTx (p = 0.68). Primary graft dysfunction, intensive care, and overall stay were the same in both groups. Survival at 1 and 8 years was 100% and 80% for DCDD versus 100% and 70% for DNDD LTx (p = 0.88), respectively. In conclusion, excellent results can be achieved for PAH LTx. DCDD donor lungs are not extended lungs per se having passed the toughest test.
authors.affiliation: Lung Transplant Service, Department of Allergy, Immunology and Respiratory Medicine, The Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: B J
authors.initials: BJ
authors.lastname: Levvey
authors.affiliation: Lung Transplant Service, Department of Allergy, Immunology and Respiratory Medicine, The Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: H M
authors.initials: HM
authors.lastname: Whitford
authors.affiliation: Lung Transplant Service, Department of Allergy, Immunology and Respiratory Medicine, The Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: T J
authors.initials: TJ
authors.lastname: Williams
authors.affiliation: Lung Transplant Service, Department of Allergy, Immunology and Respiratory Medicine, The Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: G P
authors.initials: GP
authors.lastname: Westall
authors.affiliation: Lung Transplant Service, Department of Allergy, Immunology and Respiratory Medicine, The Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Paraskeva
authors.affiliation: Lung Transplant Service, Department of Allergy, Immunology and Respiratory Medicine, The Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: C
authors.initials: C
authors.lastname: Manterfield
authors.affiliation: Lung Transplant Service, Department of Allergy, Immunology and Respiratory Medicine, The Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: T
authors.initials: T
authors.lastname: Miller
authors.affiliation: Department of Cardiothoracic Surgery, The Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: D
authors.initials: D
authors.lastname: McGiffin
authors.affiliation: Lung Transplant Service, Department of Allergy, Immunology and Respiratory Medicine, The Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: G I
authors.initials: GI
authors.lastname: Snell
mesh_terms: D000293:Adolescent; D000328:Adult; D001315:Australia / Q000453:epidemiology; D001775:Blood Circulation; D001926:Brain Death; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology*; D006085:Graft Survival; D006801:Humans; D006976:Hypertension, Pulmonary / Q000601:surgery*; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D055031:Primary Graft Dysfunction; D011379:Prognosis; D011651:Pulmonary Artery / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D014019:Tissue Donors; D009927:Tissue and Organ Procurement; D055815:Young Adult
keywords: clinical research/practice; donors and donation: donation after brain seath (DBD); donors and donation: donation after circulatory death (DCD); lung disease; lung transplantation/pulmonology