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- Title
Lung Donation and Transplant Recipient Outcomes at Independent vs Hospital-Based Donor Care Units.
- Authors
Vail, Emily A.; Wang, Xingmei; Schaubel, Douglas E.; Reese, Peter P.; Cantu, Edward; Martin, Niels D.; Abt, Peter L.; Olthoff, Kim M.; Kerlin, Meeta P.; Christie, Jason D.; Neuman, Mark D.
- Abstract
This cohort study compares lung donation rates and transplant survival outcomes in independent vs hospital-based donor care units (DCUs). Key Points: Question: Does the survival of recipients with lungs recovered and transplanted from deceased donors after brain death differ between independent and hospital-based donor care units? Findings: In this cohort study of 10 856 donors and 1657 recipients, although lung donation rates were higher among donors cared for in independent donor care units, graft survival was longer among donor lungs recovered from hospital-based units. Meaning: These findings suggest that differences in lung donation and transplantation outcomes exist and depend on the type of donor care unit used for deceased organ donor management and organ recovery. Importance: Centralizing deceased organ donor management and organ recovery into donor care units (DCUs) may mitigate the critical organ shortage by positively impacting donation and recipient outcomes. Objective: To compare donation and lung transplant outcomes between 2 common DCU models: independent (outside of acute-care hospitals) and hospital-based. Design, Setting, and Participants: This is a retrospective cohort study of Organ Procurement and Transplantation Network deceased donor registry and lung transplant recipient files from 21 US donor service areas with an operating DCU. Characteristics and lung donation rates among deceased donors cared for in independent vs hospital-based DCUs were compared. Eligible participants included deceased organ donors (aged 16 years and older) after brain death, who underwent organ recovery procedures between April 26, 2017, and June 30, 2022, and patients who received lung transplants from those donors. Data analysis was conducted from May 2023 to March 2024. Exposure: Organ recovery in an independent DCU (vs hospital-based DCU). Main Outcome and Measures: The primary outcome was duration of transplanted lung survival (through December 31, 2023) among recipients of lung(s) transplanted from cohort donors. A Cox proportional hazards model stratified by transplant year and program, adjusting for donor and recipient characteristics was used to compare graft survival. Results: Of 10 856 donors in the starting sample (mean [SD] age, 42.8 [15.2] years; 6625 male [61.0%] and 4231 female [39.0%]), 5149 (primary comparison group) underwent recovery procedures in DCUs including 1466 (28.4%) in 11 hospital-based DCUs and 3683 (71.5%) in 10 independent DCUs. Unadjusted lung donation rates were higher in DCUs than local hospitals, but lower in hospital-based vs independent DCUs (418 donors [28.5%] vs 1233 donors [33.5%]; P <.001). Among 1657 transplant recipients, 1250 (74.5%) received lung(s) from independent DCUs. Median (range) duration of follow-up after transplant was 734 (0-2292) days. Grafts recovered from independent DCUs had shorter restricted mean (SE) survival times than grafts from hospital-based DCUs (1548 [27] days vs 1665 [50] days; P =.04). After adjustment, graft failure remained higher among lungs recovered from independent DCUs than hospital-based DCUs (hazard ratio, 1.85; 95% CI, 1.28-2.65). Conclusions and Relevance: In this retrospective analysis of national donor and transplant recipient data, although lung donation rates were higher from deceased organ donors after brain death cared for in independent DCUs, lungs recovered from donors in hospital-based DCUs survived longer. These findings suggest that further work is necessary to understand which factors (eg, donor transfer, management, or lung evaluation and acceptance practices) differ between DCU models and may contribute to these differences.
- Subjects
UNITED States; LUNG transplantation; PATIENTS; TRANSPLANTATION of organs, tissues, etc.; RESEARCH funding; GRAFT survival; ORGAN donation; HOSPITALS; EVALUATION of medical care; REPORTING of diseases; DESCRIPTIVE statistics; RETROSPECTIVE studies; LONGITUDINAL method; CONFIDENCE intervals; SURVIVAL analysis (Biometry); DATA analysis software; PROPORTIONAL hazards models
- Publication
JAMA Network Open, 2024, Vol 7, Issue 6, pe2417107
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2024.17107