title: International Society for Heart and Lung Transplantation Donation After Circulatory Death Registry Report.
abstract: BACKGROUND
  The objective of this study was to review the international experience in lung transplantation using lung donation after circulatory death (DCD).
  
  
  METHODS
  In this retrospective study, data from the International Society for Heart and Lung Transplantation (ISHLT) DCD Registry were analyzed. The study cohort included DCD lung transplants performed between January 2003 and June 2013, and reported to the ISHLT DCD Registry as of April 2014. The participating institutions included 10 centers in North America, Europe and Australia. The control group was a cohort of lung recipients transplanted using brain-dead donors (DBDs) during the same study period. The primary end-point was survival after lung transplantation.
  
  
  RESULTS
  There were 306 transplants performed using DCD donors and 3,992 transplants using DBD donors during the study period. Of the DCD transplants, 94.8% were Maastricht Category III, whereas 4% were Category IV and 1.2% Category V (euthanasia). Heparin was given in 54% of the cases, donor extubation occurred in 90% of the cases, and normothermic ex vivo lung perfusion (EVLP) was used in 12%. The median time from withdrawal of life support therapy (WLST) to cardiac arrest was 15 minutes (5th to 95th percentiles of 5 to 55 minutes), and from WLST to cold flush was 33 minutes (5th to 95th percentiles of 19.5 to 79.5 minutes). Recipient age and medical diagnosis were similar in DCD and DBD groups (p = not significant [NS]). Median hospital length of stay was 18 days in DCD lung transplants and 16 days in DBD transplants (p = 0.016). Thirty-day survival was 96% in the DCD group and 97% in the DBD group. One-year survival was 89% in the DCD group and 88% in the DBD group (p = NS). Five-year survival was 61% in both groups (p = NS). The mechanism of donor death within the DCD group seemed to influence recipient early survival. The survival rates through 30 days were significantly different by donor mechanism of death (p = 0.0152). There was no significant correlation between the interval of WLST to pulmonary flush with survival (p = 0.11).
  
  
  CONCLUSIONS
  This large study of international, multi-center experience demonstrates excellent survival after lung transplantation using DCD donors. It should be further evaluated whether the mechanism of donor death influences survival after DCD transplant.
authors.affiliation: International Society for Heart and Lung Transplantation Donation after Circulatory Death Registry, Dallas, Texas. Electronic address: marcelo.cypel@uhn.ca.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Cypel
authors.affiliation: International Society for Heart and Lung Transplantation Donation after Circulatory Death Registry, Dallas, Texas.
authors.forename: Bronwyn
authors.initials: B
authors.lastname: Levvey
authors.affiliation: International Society for Heart and Lung Transplantation Donation after Circulatory Death Registry, Dallas, Texas.
authors.forename: Dirk
authors.initials: D
authors.lastname: Van Raemdonck
authors.affiliation: International Society for Heart and Lung Transplantation Donation after Circulatory Death Registry, Dallas, Texas.
authors.forename: Michiel
authors.initials: M
authors.lastname: Erasmus
authors.affiliation: International Society for Heart and Lung Transplantation Donation after Circulatory Death Registry, Dallas, Texas.
authors.forename: John
authors.initials: J
authors.lastname: Dark
authors.affiliation: International Society for Heart and Lung Transplantation Donation after Circulatory Death Registry, Dallas, Texas.
authors.forename: Robert
authors.initials: R
authors.lastname: Love
authors.affiliation: International Society for Heart and Lung Transplantation Donation after Circulatory Death Registry, Dallas, Texas.
authors.forename: David
authors.initials: D
authors.lastname: Mason
authors.affiliation: International Society for Heart and Lung Transplantation Donation after Circulatory Death Registry, Dallas, Texas.
authors.forename: Allan R
authors.initials: AR
authors.lastname: Glanville
authors.affiliation: International Society for Heart and Lung Transplantation Donation after Circulatory Death Registry, Dallas, Texas.
authors.forename: Daniel
authors.initials: D
authors.lastname: Chambers
authors.affiliation: International Society for Heart and Lung Transplantation Donation after Circulatory Death Registry, Dallas, Texas.
authors.forename: Leah B
authors.initials: LB
authors.lastname: Edwards
authors.affiliation: International Society for Heart and Lung Transplantation Donation after Circulatory Death Registry, Dallas, Texas.
authors.forename: Josef
authors.initials: J
authors.lastname: Stehlik
authors.affiliation: International Society for Heart and Lung Transplantation Donation after Circulatory Death Registry, Dallas, Texas.
authors.forename: Marshall
authors.initials: M
authors.lastname: Hertz
authors.affiliation: International Society for Heart and Lung Transplantation Donation after Circulatory Death Registry, Dallas, Texas.
authors.forename: Brian A
authors.initials: BA
authors.lastname: Whitson
authors.affiliation: International Society for Heart and Lung Transplantation Donation after Circulatory Death Registry, Dallas, Texas.
authors.forename: Roger D
authors.initials: RD
authors.lastname: Yusen
authors.affiliation: International Society for Heart and Lung Transplantation Donation after Circulatory Death Registry, Dallas, Texas.
authors.forename: Varun
authors.initials: V
authors.lastname: Puri
authors.affiliation: International Society for Heart and Lung Transplantation Donation after Circulatory Death Registry, Dallas, Texas.
authors.forename: Peter
authors.initials: P
authors.lastname: Hopkins
authors.affiliation: International Society for Heart and Lung Transplantation Donation after Circulatory Death Registry, Dallas, Texas.
authors.forename: Greg
authors.initials: G
authors.lastname: Snell
authors.affiliation: International Society for Heart and Lung Transplantation Donation after Circulatory Death Registry, Dallas, Texas.
authors.forename: Shaf
authors.initials: S
authors.lastname: Keshavjee
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology*; D006085:Graft Survival; D016041:Heart-Lung Transplantation / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data*; D006801:Humans; D007390:International Agencies; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D012955:Societies, Medical; D009927:Tissue and Organ Procurement; D055815:Young Adult
keywords: allograft ischemic time; donation after circulatory death; donor lungs allograft; lung transplantation; mortality risk factors; survival