Donor cause of brain death and related time intervals: does it affect outcome after lung transplantation?

OBJECTIVE: It remains uncertain whether donor cause of brain death (DCBD) affects survival and freedom from bronchiolitis obliterans syndrome (BOS) after lung transplantation (LTx). In addition, it is unknown whether the length of time interval from brain insult to brain death [BI-BD] and from brain death to cold preservation [BD-CP] has an impact on outcome.
METHODS: Medical charts of isolated lung transplant recipients from 400 consecutive donors were reviewed and classified according to DCBD: 190 vascular [V], 185 traumatic [T], 25 others [O]. Demographics were compared between donor groups. Hospital outcome, survival, and freedom from BOS in recipients were analyzed in relation to DCBD and related time intervals.
RESULTS: Donor age, gender, and weight differed between donor groups (p<0.001, p<0.001, p<0.05; respectively). No differences in recipient hospital outcome, survival, and freedom from BOS were found between groups. [BD-CP] longer than 10h resulted in a survival advantage (69% vs 58% and 51% vs 42% at 5 and 10 years, respectively; p<0.05) and a reduced hazard risk (0.952) of dying after LTx; (p<0.05). Multivariable analysis failed to show a significant correlation between DCBD and [BI-BD] versus survival and BOS.
CONCLUSION: DCBD and [BI-BD] do not affect survival and freedom from BOS after LTx. Lung recipients from donors certified brain dead with a time interval longer than 10h prior to organ preservation showed improved survival unrelated to BOS. This may result from longer and better donor management with reduced lung injury.