Purpose: Lung transplantation (LTx) from donors after circulatory death (DCD) has become routine with reported similar survival outcomes compared to brain-dead donor (BDD). However, it remains unknown whether possible differences in donor and recipient characteristics between various DCD categories affect outcome. Methods: Between 01/2003 and 07/2015, 516 LTx from 12 participating institutions were reported to the ISHLT DCD Registry. No uncontrolled DCDs (I and II) have yet been recorded. Ten cases after euthanasia (DCD-V) were excluded from analysis, leaving 486 DCD-III (withdrawal from life support) and 20 DCD-IV (unexpected cardiac arrest in BDD) LTx recipients. Results: Donor age tended to be higher in DCD-III. Ante-mortem heparin was administered more frequently while steroids were given less often in DCD-IV. Time interval from cardiac arrest to cold flush was longer in DCD-III. DCD-III recipients were younger with more bilateral LTx. Indication for LTx varied significantly. Total ischemic time and length of hospital stay were similar. 1, 3, and 5-year survival was 89.2%, 71.2%, 60.3% vs 94.7%, 73.7%, 49.1% in DCD-III and DCD-IV recipients, respectively (p= 0.95, log rank). Conclusion: DCD-III is the most frequent category (94%) in the Registry. Despite older donor age, less heparinization, and longer warm ischemic time interval from arrest to flush in DCD-III, early and late outcome were comparable. DCD-III do not carry an increased risk for successful LTx compared to DCD-IV.
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