Impact of Donor Brain Death Duration on Outcomes After Lung Transplantation.

Journal Article (Journal Article)

BACKGROUND: Donor brain death duration (BDD) may impact posttransplant graft function and survival in lung transplant. METHODS: We queried the 2007 to 2018 United Network for Organ Sharing Registry for adult recipients undergoing first-time isolated lung transplant. Cox proportional hazard modeling with splines enabled identification of 3 donor brain death intervals for subsequent analysis: short (<24 hours), reference (24-60 hours), and long (>60 hours). The primary outcome was posttransplant survival. RESULTS: In total, 19,721 donors and recipients met inclusion criteria. Median time from donor brain death until cross-clamp was 36.6 hours (interquartile range, 19.5). Unadjusted overall survival between cohorts was equivalent (log-rank P = .42); however, longer BDD was associated with improved bronchiolitis obliterans syndrome (BOS)-free survival (log-rank P < .001). On multivariable Cox proportional hazards regression, BDD was not associated with recipient survival (P > .05). Similarly, logistic regression did not identify an independent association between BDD and primary graft dysfunction (P > .05). Increased BDD was, however, associated with a decreased risk of acute rejection (long vs reference; adjusted odds ratio, 0.78; 95% confidence interval, 0.64-0.94) and improved BOS-free survival (long vs reference; adjusted hazard ratio, 0.88; 95% confidence interval, 0.81-0.96). CONCLUSIONS: Donor BDD is not associated with posttransplant survival or primary graft dysfunction. 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.

Full Text

Duke Authors

Cited Authors

  • Jawitz, OK; Raman, V; Barac, Y; Mulvihill, MS; Moore, C; Choi, AY; Hartwig, M; Klapper, J

Published Date

  • November 2019

Published In

Volume / Issue

  • 108 / 5

Start / End Page

  • 1519 - 1526

PubMed ID

  • 31271742

Pubmed Central ID

  • PMC6815246

Electronic International Standard Serial Number (EISSN)

  • 1552-6259

Digital Object Identifier (DOI)

  • 10.1016/j.athoracsur.2019.05.026


  • eng

Conference Location

  • Netherlands