Critical care and ventilatory management of deceased organ donors impact lung use and recipient graft survival

Elizabeth A. Swanson, Madhukar S. Patel, Michael P. Hutchens, Claus U. Niemann, Tahnee Groat, Darren J. Malinoski, Mitchell B. Sally

    Research output: Contribution to journalArticlepeer-review

    Abstract

    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.

    Original languageEnglish (US)
    Pages (from-to)4003-4011
    Number of pages9
    JournalAmerican Journal of Transplantation
    Volume21
    Issue number12
    DOIs
    StatePublished - Dec 2021

    Keywords

    • clinical research / practice
    • critical care / intensive care management
    • donors and donation: donation after brain death (DBD)
    • donors and donation: donor evaluation
    • graft survival
    • lung transplantation / pulmonology

    ASJC Scopus subject areas

    • Immunology and Allergy
    • Transplantation
    • Pharmacology (medical)

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