BACKGROUND Understanding donor factors associated with successful lung transplantation (LTx) following donation after circulatory death (DCD) is important in optimizing donor management. In this study, we examined critical care and ventilatory factors associated with DCD LTx and allograft survival using a unique detailed donor management database. METHODS The Donor Management Goals national registry was queried for DCD donors between January 2016 and July 2023. The primary outcomes were DCD lung utilization and allograft survival. Multivariable modeling was used to assess factors associated with DCD LTx and allograft survival. RESULTS A total of 3,394 donors met inclusion criteria and were included. Transplantation occurred in 202 (6.0%) cases with 85.6% 1-year survival. DCD LTx was more likely to occur following cerebrovascular accidents compared to anoxia and from donors who achieved a targeted PaO2/FiO2 (P/F) ratio at the time of organ allocation. Donor factors associated with decreased likelihood of LTx included increasing age, increasing INR, height greater than 168 cm, increasing hematocrit, and higher positive end-expiratory pressure (PEEP) at the time of organ allocation. Donor treatment with steroids and controlled mandatory ventilation, were associated with increased likelihood of graft failure at one year. CONCLUSIONS Successful DCD LTx associates with potentially modifiable donor parameters, including targeted P/F ratio, PEEP, INR, and hematocrit. Additionally, careful consideration of steroid use and ventilator settings may be important for improving long-term graft function. These modifiable factors may inform strategies to increase DCD LTx and improve survival.

中文翻译：

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循环死亡、肺利用和同种异体移植物存活率后捐献的预测因子。


背景 了解循环死亡 （DCD） 后捐献后成功肺移植 （LTx） 相关的供体因素对于优化供体管理非常重要。在这项研究中，我们使用独特的详细供体管理数据库检查了与 DCD LTx 和同种异体移植物存活相关的重症监护和通气因素。方法 在 2016 年 1 月至 2023 年 7 月期间，向捐助者管理目标国家登记处查询了 DCD 捐助者。主要结局是 DCD 肺利用和同种异体移植物存活率。多变量模型用于评估与 DCD LTx 和同种异体移植物存活相关的因素。结果 共有 3,394 名供体符合纳入标准并被纳入。移植发生在 202 例 （6.0%） 病例中，1 年生存率为 85.6%。与缺氧相比，DCD LTx 更可能发生在脑血管意外之后，并且在器官分配时达到目标 PaO2/FiO2 （P/F） 比率的供体。与 LTx 可能性降低相关的供体因素包括年龄增加、INR 增加、身高大于 168 cm、血细胞比容增加以及器官分配时呼气末正压 （PEEP） 升高。供体使用类固醇和受控强制通气治疗与一年时移植物失败的可能性增加有关。结论 成功的 DCD LTx 与潜在可改变的供体参数相关，包括靶向 P/F 比值、 PEEP 、 INR 和血细胞比容。此外，仔细考虑类固醇的使用和呼吸机设置对于改善长期移植物功能可能很重要。这些可改变的因素可能会为增加 DCD LTx 和提高生存率的策略提供信息。