The length of the warm ischemic interval in lung donation after circulatory death does not impact post-transplantation outcomes
Introduction: Transplantation of lungs obtained by donation after circulatory death (DCD) has increased the number of available organs. This study aims to determine how donor characteristics and current procurement processes (specifically, agonal and warm ischemic times) influence the outcomes exper...
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Elsevier
2025-05-01
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| Series: | JHLT Open |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2950133425000394 |
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| author | Amer Alzahrani, MD Kentaro Noda, PhD Ernest G. Chan, MD John P. Ryan, PhD Masashi Furukawa, MD, PhD Pablo G. Sanchez, MD, PhD |
| author_facet | Amer Alzahrani, MD Kentaro Noda, PhD Ernest G. Chan, MD John P. Ryan, PhD Masashi Furukawa, MD, PhD Pablo G. Sanchez, MD, PhD |
| author_sort | Amer Alzahrani, MD |
| collection | DOAJ |
| description | Introduction: Transplantation of lungs obtained by donation after circulatory death (DCD) has increased the number of available organs. This study aims to determine how donor characteristics and current procurement processes (specifically, agonal and warm ischemic times) influence the outcomes experienced by the recipients of DCD lung transplants. Materials and Methods: An analysis was conducted on United Network for Organ Sharing data collected from January 2018 to June 30, 2024, with a focus on adult recipients of double lung transplants with a DCD donor. Withdrawal-to-flush and agonal-to-flush times were divided into three non-overlapping intervals. Univariable comparisons were performed on donor and recipient characteristics and post-transplantation outcomes between intervals. Kaplan-Meier analyses were used to determine the impact of agonal and warm ischemic times on posttransplant survival. Results: The median times for withdrawal-to-flush and agonal-to-flush were 28 and 25 minutes, respectively, with closely aligned intervals. Donors in the short agonal-to-flush category were generally older and tended to be female, with no other significant donor characteristics associated with the time intervals. There were no observed associations between agonal or warm ischemic times and post-transplant outcomes, including primary graft dysfunction, ventilator dependency, and acute rejection. Kaplan-Meier survival analysis revealed no significant differences in survival between the groups (p=0.47 for withdrawal-to-flush; p=0.57 for agonal-to-flush). Conclusions: This study suggests that current variations in withdrawal-to-flush and agonal-to-flush times are not associated with DCD lung transplant outcomes. The findings underscore the need for expanding strategies to increase the utilization and availability of DCD lungs. |
| format | Article |
| id | doaj-art-cacd56be058e4e0a87d0cd7b741242c7 |
| institution | OA Journals |
| issn | 2950-1334 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Elsevier |
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| series | JHLT Open |
| spelling | doaj-art-cacd56be058e4e0a87d0cd7b741242c72025-08-20T02:16:13ZengElsevierJHLT Open2950-13342025-05-01810024410.1016/j.jhlto.2025.100244The length of the warm ischemic interval in lung donation after circulatory death does not impact post-transplantation outcomesAmer Alzahrani, MD0Kentaro Noda, PhD1Ernest G. Chan, MD2John P. Ryan, PhD3Masashi Furukawa, MD, PhD4Pablo G. Sanchez, MD, PhD5Division of Cardiothoracic Transplantation, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA; Lung Health Centre Department, Organ Transplant Centre of Excellence, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia; Corresponding author: Amer Alzahrani MD, UPMC Presbyterian C-900, 200 Lothrop St., Pittsburgh, PA 15213. Phone: +1 412 310 6829, Fax: +1 412 802 8020.Division of Cardiothoracic Transplantation, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PASection of Thoracic Surgery, Department of Surgery. University of Chicago Biological Sciences Division, Chicago, ILDivision of Cardiothoracic Transplantation, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PADivision of Cardiothoracic Transplantation, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PASection of Thoracic Surgery, Department of Surgery. University of Chicago Biological Sciences Division, Chicago, ILIntroduction: Transplantation of lungs obtained by donation after circulatory death (DCD) has increased the number of available organs. This study aims to determine how donor characteristics and current procurement processes (specifically, agonal and warm ischemic times) influence the outcomes experienced by the recipients of DCD lung transplants. Materials and Methods: An analysis was conducted on United Network for Organ Sharing data collected from January 2018 to June 30, 2024, with a focus on adult recipients of double lung transplants with a DCD donor. Withdrawal-to-flush and agonal-to-flush times were divided into three non-overlapping intervals. Univariable comparisons were performed on donor and recipient characteristics and post-transplantation outcomes between intervals. Kaplan-Meier analyses were used to determine the impact of agonal and warm ischemic times on posttransplant survival. Results: The median times for withdrawal-to-flush and agonal-to-flush were 28 and 25 minutes, respectively, with closely aligned intervals. Donors in the short agonal-to-flush category were generally older and tended to be female, with no other significant donor characteristics associated with the time intervals. There were no observed associations between agonal or warm ischemic times and post-transplant outcomes, including primary graft dysfunction, ventilator dependency, and acute rejection. Kaplan-Meier survival analysis revealed no significant differences in survival between the groups (p=0.47 for withdrawal-to-flush; p=0.57 for agonal-to-flush). Conclusions: This study suggests that current variations in withdrawal-to-flush and agonal-to-flush times are not associated with DCD lung transplant outcomes. The findings underscore the need for expanding strategies to increase the utilization and availability of DCD lungs.http://www.sciencedirect.com/science/article/pii/S2950133425000394Lung TransplantationDonation after Circulatory DeathWarm Ischemic TimeRisk FactorsOrgan DonationDonor Lungs |
| spellingShingle | Amer Alzahrani, MD Kentaro Noda, PhD Ernest G. Chan, MD John P. Ryan, PhD Masashi Furukawa, MD, PhD Pablo G. Sanchez, MD, PhD The length of the warm ischemic interval in lung donation after circulatory death does not impact post-transplantation outcomes JHLT Open Lung Transplantation Donation after Circulatory Death Warm Ischemic Time Risk Factors Organ Donation Donor Lungs |
| title | The length of the warm ischemic interval in lung donation after circulatory death does not impact post-transplantation outcomes |
| title_full | The length of the warm ischemic interval in lung donation after circulatory death does not impact post-transplantation outcomes |
| title_fullStr | The length of the warm ischemic interval in lung donation after circulatory death does not impact post-transplantation outcomes |
| title_full_unstemmed | The length of the warm ischemic interval in lung donation after circulatory death does not impact post-transplantation outcomes |
| title_short | The length of the warm ischemic interval in lung donation after circulatory death does not impact post-transplantation outcomes |
| title_sort | length of the warm ischemic interval in lung donation after circulatory death does not impact post transplantation outcomes |
| topic | Lung Transplantation Donation after Circulatory Death Warm Ischemic Time Risk Factors Organ Donation Donor Lungs |
| url | http://www.sciencedirect.com/science/article/pii/S2950133425000394 |
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