Time from Lung Transplant Donor Brain Death to Cross Clamp: An Analysis of the UNOS Registry

Purpose It has been suggested that the length of time between donor brain death and cross clamp impacts post-transplant graft function and recipient survival in lung transplantation. Methods The 2007-2018 United Network for Organ Sharing (UNOS) Registry was queried for all adult recipients undergoing isolated lung transplantation (single or bilateral) for the first time. Donation after circulatory death (DCD) donors or those with an unknown time from brain death until cross clamp were excluded. Recipients were stratified by those who received an allograft from donors with times from brain death until cross clamp less than (SHORT) or greater than (LONG) the median. The primary outcome of interest was post-transplant survival, which was evaluated with Kaplan-Meier and Cox Proportional Hazards analyses. Results 15,914 lung transplant recipients met inclusion criteria. Median time from donor brain death until cross clamp was 36 hours (IQR 17). Recipients of SHORT donors were more likely treated with IV antibiotics pre-transplant (12.3% vs 10.6%, p = 0.001) and spent a longer time on the waiting list (median 64 vs 58 days, p = 0.016). Both cohorts had similar lung allocation scores (median 40.8 vs 41.0, p = 0.292). Overall survival between the two cohorts was equivalent on Kaplan-Meier analysis (Figure 1, log-rank p = 0.776). On evaluation of other thresholds, time from donor brain death until cross clamp greater than the 75th percentile or less than the 25th percentile similarly did not impact recipient survival. After adjustment for donor and recipient characteristics, graft ischemic time, and year of transplant on Cox Proportional Hazards assessment, donor time from brain death until cross clamp was not associated with decreased survival (AHR 1.00, p = 0.981). Conclusion Time from donor brain death until cross clamp is not associated with decreased post-transplant survival. Therefore, lung allografts from donors with a prolonged length of time from brain death until explant should not be viewed less favorably. It has been suggested that the length of time between donor brain death and cross clamp impacts post-transplant graft function and recipient survival in lung transplantation. The 2007-2018 United Network for Organ Sharing (UNOS) Registry was queried for all adult recipients undergoing isolated lung transplantation (single or bilateral) for the first time. Donation after circulatory death (DCD) donors or those with an unknown time from brain death until cross clamp were excluded. Recipients were stratified by those who received an allograft from donors with times from brain death until cross clamp less than (SHORT) or greater than (LONG) the median. The primary outcome of interest was post-transplant survival, which was evaluated with Kaplan-Meier and Cox Proportional Hazards analyses. 15,914 lung transplant recipients met inclusion criteria. Median time from donor brain death until cross clamp was 36 hours (IQR 17). Recipients of SHORT donors were more likely treated with IV antibiotics pre-transplant (12.3% vs 10.6%, p = 0.001) and spent a longer time on the waiting list (median 64 vs 58 days, p = 0.016). Both cohorts had similar lung allocation scores (median 40.8 vs 41.0, p = 0.292). Overall survival between the two cohorts was equivalent on Kaplan-Meier analysis (Figure 1, log-rank p = 0.776). On evaluation of other thresholds, time from donor brain death until cross clamp greater than the 75th percentile or less than the 25th percentile similarly did not impact recipient survival. After adjustment for donor and recipient characteristics, graft ischemic time, and year of transplant on Cox Proportional Hazards assessment, donor time from brain death until cross clamp was not associated with decreased survival (AHR 1.00, p = 0.981). Time from donor brain death until cross clamp is not associated with decreased post-transplant survival. Therefore, lung allografts from donors with a prolonged length of time from brain death until explant should not be viewed less favorably.