Abstract：
OBJECTIVE: Donation after circulatory death (DCD) donors offer the ability to expand the lung donor pool and ex vivo lung perfusion (EVLP) further contributes to this ability by allowing for additional evaluation and resuscitation of these extended criteria donors. We sought to determine the outcomes of recipients receiving organs from DCD EVLP donors in a multicenter setting.
METHODS: This was an unplanned post hoc analysis of a multicenter, prospective, nonrandomized trial that took place during 2011 to 2017 with 3 years of follow-up. Patients were placed into 3 groups based off procurement strategy: brain-dead donor (control), brain-dead donor evaluated by EVLP, and DCD donors evaluated by EVLP. The primary outcomes were severe primary graft dysfunction at 72 hours and survival. Secondary outcomes included select perioperative outcomes, and 1-year and 3-years allograft function and quality of life measures.
RESULTS: The DCD EVLP group had significantly higher incidence of severe primary graft dysfunction at 72 hours (P = .03), longer days on mechanical ventilation (P < .001) and in-hospital length of stay (P = .045). Survival at 3 years was 76.5% (95% CI, 69.2%-84.7%) for the control group, 68.3% (95% CI, 58.9%-79.1%) for the brain-dead donor group, and 60.7% (95% CI, 45.1%-81.8%) for the DCD group (P = .36). At 3-year follow-up, presence observed bronchiolitis obliterans syndrome or quality of life metrics did not differ among the groups.
CONCLUSIONS: Although DCD EVLP allografts might not be appropriate to transplant in every candidate recipient, the expansion of their use might afford recipients stagnant on the waitlist a viable therapy.
METHODS: This was an unplanned post hoc analysis of a multicenter, prospective, nonrandomized trial that took place during 2011 to 2017 with 3 years of follow-up. Patients were placed into 3 groups based off procurement strategy: brain-dead donor (control), brain-dead donor evaluated by EVLP, and DCD donors evaluated by EVLP. The primary outcomes were severe primary graft dysfunction at 72 hours and survival. Secondary outcomes included select perioperative outcomes, and 1-year and 3-years allograft function and quality of life measures.
RESULTS: The DCD EVLP group had significantly higher incidence of severe primary graft dysfunction at 72 hours (P = .03), longer days on mechanical ventilation (P < .001) and in-hospital length of stay (P = .045). Survival at 3 years was 76.5% (95% CI, 69.2%-84.7%) for the control group, 68.3% (95% CI, 58.9%-79.1%) for the brain-dead donor group, and 60.7% (95% CI, 45.1%-81.8%) for the DCD group (P = .36). At 3-year follow-up, presence observed bronchiolitis obliterans syndrome or quality of life metrics did not differ among the groups.
CONCLUSIONS: Although DCD EVLP allografts might not be appropriate to transplant in every candidate recipient, the expansion of their use might afford recipients stagnant on the waitlist a viable therapy.
摘要：
目的：循环性死亡（DCD）供体提供了扩大肺供体库的能力，离体肺灌注（EVLP）通过允许对这些扩展标准供体进行额外的评估和复苏，进一步有助于这种能力。我们试图确定在多中心环境中接受DCDEVLP供体器官的接受者的结果。
方法：这是对多中心的计划外事后分析，prospective,非随机试验于2011年至2017年期间进行，随访3年。根据非采购策略将患者分为3组：脑死亡供体（对照），由EVLP评估的脑死亡捐赠者，和EVLP评估的DCD供体。主要结果是72小时时严重的原发性移植物功能障碍和存活。次要结局包括选择围手术期结局，1年和3年同种异体移植功能和生活质量的测量。
结果：DCDEVLP组在72小时时严重原发性移植物功能障碍的发生率明显更高（P=0.03），机械通气天数（P<.001）和住院时间（P=.045）。对照组3年生存率为76.5%(95%CI,69.2%-84.7%),脑死亡供体组的68.3%（95%CI，58.9%-79.1%），DCD组为60.7%（95%CI，45.1%-81.8%）（P=0.36）。在3年的随访中，观察到的闭塞性细支气管炎综合征或生活质量指标在各组之间没有差异.
结论：尽管DCDEVLP同种异体移植物可能不适合移植到每个候选受体中，他们使用的扩大可能会给等待名单上的接受者提供一种可行的治疗方法。
方法：这是对多中心的计划外事后分析，prospective,非随机试验于2011年至2017年期间进行，随访3年。根据非采购策略将患者分为3组：脑死亡供体（对照），由EVLP评估的脑死亡捐赠者，和EVLP评估的DCD供体。主要结果是72小时时严重的原发性移植物功能障碍和存活。次要结局包括选择围手术期结局，1年和3年同种异体移植功能和生活质量的测量。
结果：DCDEVLP组在72小时时严重原发性移植物功能障碍的发生率明显更高（P=0.03），机械通气天数（P<.001）和住院时间（P=.045）。对照组3年生存率为76.5%(95%CI,69.2%-84.7%),脑死亡供体组的68.3%（95%CI，58.9%-79.1%），DCD组为60.7%（95%CI，45.1%-81.8%）（P=0.36）。在3年的随访中，观察到的闭塞性细支气管炎综合征或生活质量指标在各组之间没有差异.
结论：尽管DCDEVLP同种异体移植物可能不适合移植到每个候选受体中，他们使用的扩大可能会给等待名单上的接受者提供一种可行的治疗方法。
