Lung Transplantation from Controlled and Uncontrolled Donation after Circulatory Death Donors. Single Centre Experience

PURPOSE: We started our uncontrolled donation after circulatory death (DCD) experience in 2014 with the first successful lung transplantation (LT). After a long period of local logistical reassessment, in 2017 we resumed the process managing both uncontrolled and controlled DCD. This cohort study reviews early outcome of our initial series of LT from DCD donors and matches it with the outcome of patients transplanted with graft from donation after brain death (DBD) donors in the same period. METHODS: This is a single-institution, retrospective study on data collected prospectively from adult patients who underwent bilateral LT at our Centre between 10/2017 and 07/2019. Our DCD procurement protocol consists of: 1) an in situ graft preservation with open-lung approach (cPAP); 2) non-rapid normothermic lung procurement isolated (only-lung uncontrolled setting) or during abdominal normothermic regional perfusion, namely without pleural topical cooling before the start of PA flushing (multiorgan controlled setting); 3) ex-situ assessment/evaluation with machine perfusion (EVLP or OCS) before LT. RESULTS: In the study period 51 subjects respected inclusion criteria (Table). Ten of these were from DCD donors (19.6%; 6 cDCD and 4 uDCD). The flow-chart shows the DCD experience (Image). CONCLUSION: Our DCD program increased the LT number with an adequate early-intermediate outcome, despite extended periods of warm ischemia. Our results suggest that LT from DCD donors is feasible in controlled and uncontrolled setting, in isolated and combined organs procurement.