Donation after circulatory death donors in highrisk recipients undergoing bilateral lung transplantation: An ISHLT database registry analysis

Lung transplantation (LTx) using donation after circulatory death (DCD) donors has demonstrated equivalent outcomes compared to donation after brain dead (DBD) donors. However, data from the use of DCDs for high-risk (HR) recipients is limited. We performed a propensity match study to evaluate the impact of DCD transplantation on HR recipients. In addition, we assessed the effect of recipient profile (HR vs. non-HR) in DCDs and DBDs LTx. From 2009-2018, 1829 double lung transplants (DLTx) for HR recipients were identified. Of these, 131 were performed using DCD donors. There was no difference in survival between DCDs and DBDs among HR-DLTx recipients (p = 0.16). However, HR recipients had worse survival compared to nonHR recipients in DBD (p < 0.001) but not in DCD transplantation (p = 0.95). Our findings support that DCD lungs are appropriate for HR recipients and should not be considered inferior or higher-risk donors. Its use should be further stimulated rather than restricted. J Heart Lung Transplant 2022;41:712- 715 (c) 2022 International Society for Heart and Lung Transplantation. All rights reserved.