TY - JOUR
T1 - Critical care and ventilatory management of deceased organ donors impact lung use and recipient graft survival
AU - Swanson, Elizabeth A.
AU - Patel, Madhukar S.
AU - Hutchens, Michael P.
AU - Niemann, Claus U.
AU - Groat, Tahnee
AU - Malinoski, Darren J.
AU - Sally, Mitchell B.
N1 - Publisher Copyright:
© 2021 The American Society of Transplantation and the American Society of Transplant Surgeons.
PY - 2021/12
Y1 - 2021/12
N2 - Current risk-adjusted models for donor lung use and lung graft survival do not include donor critical care data. We sought to identify modifiable donor physiologic and mechanical ventilation parameters that predict donor lung use and lung graft survival. This is a prospective observational study of donors after brain death (DBDs) managed by 19 Organ Procurement Organizations from 2016 to 2019. Demographics, mechanical ventilation parameters, and critical care data were recorded at standardized time points during donor management. The lungs were transplanted from 1811 (30%) of 6052 DBDs. Achieving ≥7 critical care endpoints was a positive predictor of donor lung use. After controlling for recipient factors, donor blood pH positively predicted lung graft survival (OR 1.48 per 0.1 unit increase in pH) and the administration of dopamine during donor management negatively predicted lung graft survival (OR 0.19). Tidal volumes ≤8 ml/kg predicted body weight (OR 0.65), and higher positive end-expiratory pressures (OR 0.91 per cm H2O) predicted decreased donor lung use without affecting lung graft survival. A randomized clinical trial is needed to inform optimal ventilator management strategies in DBDs.
AB - Current risk-adjusted models for donor lung use and lung graft survival do not include donor critical care data. We sought to identify modifiable donor physiologic and mechanical ventilation parameters that predict donor lung use and lung graft survival. This is a prospective observational study of donors after brain death (DBDs) managed by 19 Organ Procurement Organizations from 2016 to 2019. Demographics, mechanical ventilation parameters, and critical care data were recorded at standardized time points during donor management. The lungs were transplanted from 1811 (30%) of 6052 DBDs. Achieving ≥7 critical care endpoints was a positive predictor of donor lung use. After controlling for recipient factors, donor blood pH positively predicted lung graft survival (OR 1.48 per 0.1 unit increase in pH) and the administration of dopamine during donor management negatively predicted lung graft survival (OR 0.19). Tidal volumes ≤8 ml/kg predicted body weight (OR 0.65), and higher positive end-expiratory pressures (OR 0.91 per cm H2O) predicted decreased donor lung use without affecting lung graft survival. A randomized clinical trial is needed to inform optimal ventilator management strategies in DBDs.
KW - clinical research / practice
KW - critical care / intensive care management
KW - donors and donation: donation after brain death (DBD)
KW - donors and donation: donor evaluation
KW - graft survival
KW - lung transplantation / pulmonology
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U2 - 10.1111/ajt.16719
DO - 10.1111/ajt.16719
M3 - Article
C2 - 34129720
AN - SCOPUS:85109392746
SN - 1600-6135
VL - 21
SP - 4003
EP - 4011
JO - American Journal of Transplantation
JF - American Journal of Transplantation
IS - 12
ER -