Impact of Dual Heart and Lung Recovery from Donation after Circulatory Death Donors on Thoracic Transplant Outcomes

A. L. Zhou¹, J. Moore. Ruck², A. F. Akbar¹, A. Kalra³, A. J.. Casillan⁴, J. S. Ha⁵, C. A. Merlo², A. Kilic⁶, E. L. Bush^7
1Johns Hopkins School of Medicine, Baltimore, Maryland ²Johns Hopkins University School of Medicine, Baltimore, Maryland ³Johns Hopkins School of Medicine; Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania ⁴Johns Hopkins Hospital, Baltimore, Maryland ⁵Johns Hopkins Hospital, Glenwood, Maryland ⁶The Johns Hopkins Hospital, Baltimore, Maryland ⁷The Johns Hopkins University, Dept. of Surgery, Division of Thoracic, Baltimore, Maryland

Purpose: Concomitant heart and lung recovery can result in increased operative complexity, ischemic time, and competition for resources and anatomic territory, particularly with donation after circulatory death (DCD) donors. We investigated the effects of dual heart and lung recovery from DCD donors on thoracic transplant outcomes.

Methods: Adult thoracic (heart or lung) DCD transplants occurring between 2019 and 2022 in the United Network for Organ Sharing database were included in this study. Multiorgan transplants were excluded. Transplants were stratified based on whether the donor was a dual, lung-only, or heart-only donor (dual vs. lung vs. heart donor). Post-transplant hospital length of stay and pre-discharge acute rejection were investigated using rank-sum testing and multivariable logistic regressions, respectively. Post-operative survival at 30 days and 1 year post-transplant were investigated using multivariable Cox regressions. All multivariable models adjusted for baseline characteristics with p< 0.2 on univariate analysis.

Results: Of the total 1237 DCD donors, 7.0% were dual, 51.1% were lung-only, and 41.9% were heart-only. Of the 741 lung transplants, 88 (11.9%) utilized dual donors; this percentage increased from 1.3% in 2019 to 22.5% in 2022 (p < 0.001). Dual vs. lung donors were younger, more likely to be male, and less likely to die of stroke, and recipients of dual donors were more likely to be white (Table). Transplants from dual vs. lung donors had similar median length of stay (23 vs. 24 days, p=0.87), acute rejection (6.8% vs. 8.9%; OR 0.82 [95%CI: 0.34-2.00, p=0.66), and survival at 30 days (97.7% vs. 96.8%; aHR 0.72 [95%CI: 0.16-3.14], p=0.66) and 1 year (88.3% vs. 85.0%; aHR 0.96 [95%CI: 0.46-2.01], p=0.92; Figure) post-transplant. Of the 605 heart transplants, 87 (14.4%) utilized dual donors. Dual vs. heart donors were younger, and recipients of dual donors were more likely to be male (Table). Transplants from dual vs. heart donors had similar length of stay (17 vs. 16, p=0.43), acute rejection (13.8% vs. 18.0%; OR 0.66 [95%CI: 0.35-1.28], p=0.22), and survival at 30 days (98.9% vs. 97.5%; aHR 0.53 [95%CI: 0.07-4.12], p=0.55) and 1 year (96.3% vs. 92.0%; aHR 0.49 [95%CI: 0.15-1.60], p=0.24; Figure).

Conclusion: Dual heart and lung recovery from DCD donors does not negatively impact outcomes of thoracic transplants. These findings should encourage providers to maximize organ recovery from DCD donors to increase the donor pool for heart and lung transplantation.

Identify the source of the funding for this research project: This work was supported by the Pozefsky Scholars Program.