Experience of Lung Transplantation using Voluntary Organ Donations after Brain and Cardiac Death of Citizens at Wuxi Center—Report of 242 Cases

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Wuxi lung transplant group.Background Voluntary organ donation after death of citizens has become the sole source of organ transplant in Mainland China from January 2015. However,limited data was published on lung transplantation using lungs from donation after brain death(DBD),donation after brain and cardiac death(DBCD) or donation after cardiac death(DCD) in China. The purpose of the study was to review the progress of new lung transplant program at our center. Methods Retrospective data from Chinese network registry for lung transplantation performed in our center were evaluated between January, 2015 and December,2016. Clinical characteristics of donors and recipients were reviewed, all transplants were approved by the Ethics Committee of our hospital. Results A total of 231 DBCD,DBD or DCD patients donated their lungs,the main causes of death were cardiac arrest,craniocerebral trauma and celebral vascular incidence.The mean age for these donors were 32.53 (15-57)years old,with a mean ventilation time of 4.58(1-15) days in the intensive care unit.Usually,two days were frequently requested for us to perform organ procurement,and great efforts were needed to transport the donor lungs to our center in China,1-4 hours were frequently required by route of highway,4-6 by highway and high-speed rail,5.5-11 hours by civil aviation, high-speed rail,and highway.There were 242 lung transplantations performed using lungs from DBCD,DBD or DCD during the study period.The mean age of recipients was 53.87(13-75) years old,with 191 males(78.9%) and 51 females(21.1%),137 patients received bilateral lung transplantation,105 underwent single lung transplantation, including 8 cases of bilateral split lobar transplantations. The main indications for this cohort were 141 cases of idiopathic pulmonary fibrosis,37 chronic obstructive pulmonary disease, 23 silicosis,18 bronchiectasis,9 lymphangioleiomyomatosis,5 bronchiolitis obliterans,4 pulmonary hypertesion, 2 graft versus host lung disease after allogenic hematopoietic stem cell transplantation,1 eisenmenger syndrome, 1 chronic pulmonary embolism,and 1 cystic fibrosis.Extracorporeal membrane oxygenation(ECMO) was used in 53.3% of the patients(129cases),with 54 recipients not weaned from ECMO immediately after transplants.There were 42 death during perioperative period,including 20 cases of primary graft dysfunction,11 sepsis,6 multiple organ failure,3 sudden death,and 2 for other causes.One year survival postoperatively was 77.5%. Three-month and one-year survival were 82.6% and 78.3%, respectively. Conclusion Lung transplantation using donors from DBCD, DBD or DCD facilitates the implementation of new lung transplant program at a large center in China.

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