Impact of donor brain death duration on outcomes following lung transplantation.
BACKGROUND: Donor brain death duration (BDD) may impact post-transplant graft function and survival in lung transplantation. METHODS: We queried the 2007-2018 United Network for Organ Sharing Registry for adult recipients undergoing first-time isolated lung transplantation. Cox Proportional Hazard modelling with splines enabled identification of three donor brain death intervals for subsequent analysis: short (<24 hours), reference (24-60 hours), and long (>60 hours). The primary outcome was post-transplant survival. RESULTS: 19,721 donors and recipients met inclusion criteria. Median time from donor brain death until cross clamp was 36.6 hours (IQR 19.5). Unadjusted overall survival between cohorts was equivalent (log-rank p=0.42), however longer BDD was associated with improved bronchiolitis obliterans syndrome (BOS)-free survival (log-rank p<0.001). On multivariable Cox Proportional Hazards regression, BDD was not associated with recipient survival (p>0.05). Similarly, logistic regression did not identify an independent association between BDD and primary graft dysfunction (PGD) (p>0.05). Increased BDD was, however, associated with a decreased risk of acute rejection (long vs reference, adjusted OR 0.78, 95% CI 0.64-0.94) and improved BOS-free survival (long vs reference, adjusted HR 0.88, 95% CI 0.81-0.96). CONCLUSIONS: Donor BDD is not associated with post-transplant survival or PGD. Long donor BDD, however, is associated with a decreased risk for acute rejection and improved BOS-free survival. Therefore, lung allografts from donors with a prolonged length of time from brain death until explant should not be viewed less favorably by donor selection centers.
Jawitz, OK; Raman, V; Barac, Y; Mulvihill, MS; Moore, C; Choi, AY; Hartwig, M; Klapper, J
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