European Journal of Cardio-Thoracic Surgery vol:39 issue:4 pages:E68-E76
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 . Demographics were compared between donor groups. Hospital outcome, survival, and freedom from BUS 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 BUS were found between groups. [BD-CP] longer than 10 h 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 BUS. Conclusion: DCBD and [BI-BD] do not affect survival and freedom from BUS after LTx. Lung recipients from donors certified brain dead with a time interval longer than 10 h prior to organ preservation showed improved survival unrelated to BUS. This may result from longer and better donor management with reduced lung injury. (C) 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.