Interdisciplinary cardiovascular and thoracic surgery · 2026
Outcomes of Lung Transplantation From Asphyxiation Donors: Reassessing Hypoxic Injury and Implications for Donation After Circulatory Death.
СтатьяНазвание и аннотация: Перевод в очереди
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Kwon Ye In Christopher, Ambrosio Matthew, Keller Michael, Hage Chadi A, Schwartz Gary, Keshavamurthy Suresh, Patel Vipul, Shah Rachit D, Kasirajan Vigneshwar, Hashmi Zubair A
Аннотация
OBJECTIVES: With persistent donor shortages limiting lung transplantation (LT), optimizing the use of extended-criteria donors is essential. Asphyxiation (AXP) and donation after circulatory death (DCD) donors both experience hypoxic-ischaemic injury, raising concern for graft performance. We evaluated the long-term outcomes of AXP donor LT and the effect of ex vivo lung perfusion (EVLP) on survival.
METHODS: Adult recipients (≥18 years) of primary LT (2014-2024) in the United Network for Organ Sharing registry were stratified by donor cause of death: AXP vs non-AXP. Survival was estimated by Kaplan-Meier analysis, and multivariable Cox regression identified factors associated with mortality. Subgroup analyses examined EVLP and DCD vs donation after brain death (DBD) cohorts.
RESULTS: Among 26 334 LT recipients, 1406 (5.3%) received AXP donor lungs. Asphyxiation donors were more frequently DCD (9.5% vs 6%, P < .001). Ten-year recipient (25.2% vs 27.4%; P = .67) and graft (24.1% vs 26.8%; P = .72) survival were comparable, and AXP status was not independently associated with mortality after adjusting for allocation era (HR 1.01, 95% CI, 0.91-1.11, P = .908). However, EVLP use in AXP lungs correlated with decreased 3-year survival (55.3% vs 74.1%; P = .035). Sensitivity analyses demonstrated significant differences among the 4 donor subgroups (DCD-AXP, DCD non-AXP, DBD-AXP, and DBD non-AXP) on overall comparison (P = .008), with DCD-AXP recipients exhibiting numerically the highest 5-year survival rates.
CONCLUSIONS: AXP donor lungs provide comparable long-term outcomes, and DCD-AXP grafts do not appear to confer inferior survival. The interaction between AXP and EVLP use warrants further study to refine donor reconditioning strategies.
METHODS: Adult recipients (≥18 years) of primary LT (2014-2024) in the United Network for Organ Sharing registry were stratified by donor cause of death: AXP vs non-AXP. Survival was estimated by Kaplan-Meier analysis, and multivariable Cox regression identified factors associated with mortality. Subgroup analyses examined EVLP and DCD vs donation after brain death (DBD) cohorts.
RESULTS: Among 26 334 LT recipients, 1406 (5.3%) received AXP donor lungs. Asphyxiation donors were more frequently DCD (9.5% vs 6%, P < .001). Ten-year recipient (25.2% vs 27.4%; P = .67) and graft (24.1% vs 26.8%; P = .72) survival were comparable, and AXP status was not independently associated with mortality after adjusting for allocation era (HR 1.01, 95% CI, 0.91-1.11, P = .908). However, EVLP use in AXP lungs correlated with decreased 3-year survival (55.3% vs 74.1%; P = .035). Sensitivity analyses demonstrated significant differences among the 4 donor subgroups (DCD-AXP, DCD non-AXP, DBD-AXP, and DBD non-AXP) on overall comparison (P = .008), with DCD-AXP recipients exhibiting numerically the highest 5-year survival rates.
CONCLUSIONS: AXP donor lungs provide comparable long-term outcomes, and DCD-AXP grafts do not appear to confer inferior survival. The interaction between AXP and EVLP use warrants further study to refine donor reconditioning strategies.