• DOI:10.1111/tri.13754
• Corpus ID: 222162950

Utilization of extracorporeal membrane oxygenation in DCD and DBD lung transplants: a 2‐year single‐center experience

@article{Sef2020UtilizationOE,
  title={Utilization of extracorporeal membrane oxygenation in DCD and DBD lung transplants: a 2‐year single‐center experience},
  author={Davorin Sef and Alessandra Verzelloni Sef and Prashant N Mohite and Ulrich Stock and Vladimir Trkulja and Binu Raj and Diana Garcia Saez and Balakrishnan Mahesh and Fabio de Robertis and Andr{\'e} Ruediger Simon},
  journal={Transplant International},
  year={2020},
  volume={33}
}

• D. Sef, Alessandra Verzelloni Sef, +7 authors A. Simon
• Published 29 September 2020
• Medicine, Biology
• Transplant International

Donation after circulatory death (DCD) has the potential to expand the lung donor pool. We aimed to assess whether DCD affected the need for perioperative extracorporeal membrane oxygenation (ECMO) and perioperative outcomes in lung transplantation (LTx) as compared to donation after brain death (DBD). All consecutive LTxs performed between April 2017 and March 2019 at our tertiary center were analyzed. Donor and recipient preoperative characteristics, utilization of ECMO, and perioperative clinical outcomes were compared between DCD and DBD LTx. Multivariate models (frequentist and Bayes) were fitted to evaluate an independent effect of DCD on the intra‐ and postoperative need for ECMO. Out of 105 enrolled patients, 25 (23.8%) were DCD LTx. Donors’ and preoperative recipients’ characteristics were comparable between the groups. Intraoperatively, mechanical circulatory support (MCS) was more common in DCD LTx (56.0% vs. 36.2%), but the adjusted difference was minor (RR = 1.16, 95% CI 0.64–2.12; P = 0.613). MCS duration, and first and second lung ischemia time were longer in the DCD group. Postoperatively, DCD recipients more commonly required ECMO (32.0% vs. 7.5%) and the difference remained considerable after adjustment for the pre‐ and intraoperative covariates: RR = 4.11 (95% CI 0.95–17.7), P = 0.058, Bayes RR = 4.15 (95% CrI 1.28–13.0). Sensitivity analyses (two DCD‐DBD matching procedures) supported a higher risk of postoperative ECMO need in DCD patients. Incidence of delayed chest closure, postoperative chest drainage, and renal replacement therapy was higher in the DCD group. Early postoperative outcomes after DCD LTx appeared generally comparable to those after DBD LTx. DCD was associated with a higher need for postoperative ECMO which could influence clinical outcomes. However, as the DCD group had a significantly higher use of EVLP with more common ECMO preoperatively, this might have contributed to worse outcomes in the DCD group.