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AUSTIN, TEX. – The risk of death at 1 year after lung transplantation with organs donated either after cardiac arrest or after brain death was virtually the same, an analysis of the literature has shown.
“Donation after cardiac death appears to be a safe and effective method to expand the donor pool,” said Dr. Dustin Krutsinger of the University of Iowa, Iowa City, who presented the findings during the Hot Topics in Pulmonary Critical Care session at the annual meeting of the American College of Chest Physicians.
Over the years, the demand for organ donations for lung transplant candidates has steadily increased while the number of available organs has remained static. This is due, in part, to physicians being concerned about injury to the organs during the ischemic period, as well as what can often be as much as an hour before organ procurement after withdrawal of life support. However, Dr. Krutsinger said the similarities between the two cohorts could result from the fact that before procurement, systemic circulation allows the lungs to oxygenate by perfusion, and so there is less impact during the ischemic period.
“There is also a thought that the ischemic period might actually protect the lungs and the liver from reperfusion injury. And we’re avoiding brain death, which is not a completely benign state,” he told the audience.
After conducting an extensive review of the literature for 1-year survival rates post lung transplantation, the investigators found 519 unique citations, including 58 citations selected for full text review, 10 observational cohort studies for systematic review, and another 5 such studies for meta-analysis.
Dr. Krutsinger and his colleagues found no significant difference in 1-year survival rates between the donation after cardiac death and the donation after brain death cohorts (P = .658). In a pooled analysis of the five studies, no significant difference in risk of death was found at 1 year after either transplantation procedure (relative risk, 0.66; 95% confidence interval, 0.38-1.15; P = .15). Although he thought the findings were limited by shortcomings in the data, such as the fact that the study was a retrospective analysis of unmatched cohorts and that the follow-up period was short, Dr. Krutsinger said in an interview that he thought the data were compelling enough for institutions to begin rethinking organ procurement and transplantation protocols. In addition to his own study, he cited a 2013 study which he said indicated that if lungs donated after cardiac arrest were included, the pool of available organs would increase by as much as 50% (Ann. Am. Thorac. Soc. 2013;10:73-80).
But challenges remain.
“There are some things you can do to the potential donors that are questionable ethicswise, such as administering heparin premortem, which would be beneficial to the actual recipients. But, up until they are pronounced dead, they are still a patient. You don’t really have that complication with a donation after brain death, since once brain death is determined, the person is officially dead. Things you then do to them to benefit the eventual recipients aren’t being done to a ‘patient.’ ”
Still, Dr. Krutsinger said that if organs procured after cardiac arrest were to become more common than after brain death, he would be “disappointed” since the data showed “the outcomes are similar, not inferior.”
Dr. Krutsinger said he had no relevant disclosures.
On Twitter @whitneymcknight
AUSTIN, TEX. – The risk of death at 1 year after lung transplantation with organs donated either after cardiac arrest or after brain death was virtually the same, an analysis of the literature has shown.
“Donation after cardiac death appears to be a safe and effective method to expand the donor pool,” said Dr. Dustin Krutsinger of the University of Iowa, Iowa City, who presented the findings during the Hot Topics in Pulmonary Critical Care session at the annual meeting of the American College of Chest Physicians.
Over the years, the demand for organ donations for lung transplant candidates has steadily increased while the number of available organs has remained static. This is due, in part, to physicians being concerned about injury to the organs during the ischemic period, as well as what can often be as much as an hour before organ procurement after withdrawal of life support. However, Dr. Krutsinger said the similarities between the two cohorts could result from the fact that before procurement, systemic circulation allows the lungs to oxygenate by perfusion, and so there is less impact during the ischemic period.
“There is also a thought that the ischemic period might actually protect the lungs and the liver from reperfusion injury. And we’re avoiding brain death, which is not a completely benign state,” he told the audience.
After conducting an extensive review of the literature for 1-year survival rates post lung transplantation, the investigators found 519 unique citations, including 58 citations selected for full text review, 10 observational cohort studies for systematic review, and another 5 such studies for meta-analysis.
Dr. Krutsinger and his colleagues found no significant difference in 1-year survival rates between the donation after cardiac death and the donation after brain death cohorts (P = .658). In a pooled analysis of the five studies, no significant difference in risk of death was found at 1 year after either transplantation procedure (relative risk, 0.66; 95% confidence interval, 0.38-1.15; P = .15). Although he thought the findings were limited by shortcomings in the data, such as the fact that the study was a retrospective analysis of unmatched cohorts and that the follow-up period was short, Dr. Krutsinger said in an interview that he thought the data were compelling enough for institutions to begin rethinking organ procurement and transplantation protocols. In addition to his own study, he cited a 2013 study which he said indicated that if lungs donated after cardiac arrest were included, the pool of available organs would increase by as much as 50% (Ann. Am. Thorac. Soc. 2013;10:73-80).
But challenges remain.
“There are some things you can do to the potential donors that are questionable ethicswise, such as administering heparin premortem, which would be beneficial to the actual recipients. But, up until they are pronounced dead, they are still a patient. You don’t really have that complication with a donation after brain death, since once brain death is determined, the person is officially dead. Things you then do to them to benefit the eventual recipients aren’t being done to a ‘patient.’ ”
Still, Dr. Krutsinger said that if organs procured after cardiac arrest were to become more common than after brain death, he would be “disappointed” since the data showed “the outcomes are similar, not inferior.”
Dr. Krutsinger said he had no relevant disclosures.
On Twitter @whitneymcknight
AUSTIN, TEX. – The risk of death at 1 year after lung transplantation with organs donated either after cardiac arrest or after brain death was virtually the same, an analysis of the literature has shown.
“Donation after cardiac death appears to be a safe and effective method to expand the donor pool,” said Dr. Dustin Krutsinger of the University of Iowa, Iowa City, who presented the findings during the Hot Topics in Pulmonary Critical Care session at the annual meeting of the American College of Chest Physicians.
Over the years, the demand for organ donations for lung transplant candidates has steadily increased while the number of available organs has remained static. This is due, in part, to physicians being concerned about injury to the organs during the ischemic period, as well as what can often be as much as an hour before organ procurement after withdrawal of life support. However, Dr. Krutsinger said the similarities between the two cohorts could result from the fact that before procurement, systemic circulation allows the lungs to oxygenate by perfusion, and so there is less impact during the ischemic period.
“There is also a thought that the ischemic period might actually protect the lungs and the liver from reperfusion injury. And we’re avoiding brain death, which is not a completely benign state,” he told the audience.
After conducting an extensive review of the literature for 1-year survival rates post lung transplantation, the investigators found 519 unique citations, including 58 citations selected for full text review, 10 observational cohort studies for systematic review, and another 5 such studies for meta-analysis.
Dr. Krutsinger and his colleagues found no significant difference in 1-year survival rates between the donation after cardiac death and the donation after brain death cohorts (P = .658). In a pooled analysis of the five studies, no significant difference in risk of death was found at 1 year after either transplantation procedure (relative risk, 0.66; 95% confidence interval, 0.38-1.15; P = .15). Although he thought the findings were limited by shortcomings in the data, such as the fact that the study was a retrospective analysis of unmatched cohorts and that the follow-up period was short, Dr. Krutsinger said in an interview that he thought the data were compelling enough for institutions to begin rethinking organ procurement and transplantation protocols. In addition to his own study, he cited a 2013 study which he said indicated that if lungs donated after cardiac arrest were included, the pool of available organs would increase by as much as 50% (Ann. Am. Thorac. Soc. 2013;10:73-80).
But challenges remain.
“There are some things you can do to the potential donors that are questionable ethicswise, such as administering heparin premortem, which would be beneficial to the actual recipients. But, up until they are pronounced dead, they are still a patient. You don’t really have that complication with a donation after brain death, since once brain death is determined, the person is officially dead. Things you then do to them to benefit the eventual recipients aren’t being done to a ‘patient.’ ”
Still, Dr. Krutsinger said that if organs procured after cardiac arrest were to become more common than after brain death, he would be “disappointed” since the data showed “the outcomes are similar, not inferior.”
Dr. Krutsinger said he had no relevant disclosures.
On Twitter @whitneymcknight
AT CHEST 2014
Key clinical point: Expansion of organ donation programs to include organs donated after cardiac death could help meet a growing demand for donated lungs.
Major finding: No significant difference was seen in lung transplantation 1-year survival rates between donation after cardiac arrest and donation after brain death.
Data source: A systematic review of 10 observational cohort studies and a meta-analysis of 5 studies, chosen from more than 500 citations that included 1-year survival data for lung transplantation occuring after either cardiac arrest or brain death.
Disclosures: Dr. Krutsinger said he had no relevant disclosures.
