@article{b96b8eda40b14cdc93dc864af86d6d4a,
title = "Critical care and ventilatory management of deceased organ donors impact lung use and recipient graft survival",
abstract = "Current risk-adjusted models for donor lung use and lung graft survival do not include donor critical care data. We sought to identify modifiable donor physiologic and mechanical ventilation parameters that predict donor lung use and lung graft survival. This is a prospective observational study of donors after brain death (DBDs) managed by 19 Organ Procurement Organizations from 2016 to 2019. Demographics, mechanical ventilation parameters, and critical care data were recorded at standardized time points during donor management. The lungs were transplanted from 1811 (30%) of 6052 DBDs. Achieving ≥7 critical care endpoints was a positive predictor of donor lung use. After controlling for recipient factors, donor blood pH positively predicted lung graft survival (OR 1.48 per 0.1 unit increase in pH) and the administration of dopamine during donor management negatively predicted lung graft survival (OR 0.19). Tidal volumes ≤8 ml/kg predicted body weight (OR 0.65), and higher positive end-expiratory pressures (OR 0.91 per cm H2O) predicted decreased donor lung use without affecting lung graft survival. A randomized clinical trial is needed to inform optimal ventilator management strategies in DBDs.",
keywords = "clinical research / practice, critical care / intensive care management, donors and donation: donation after brain death (DBD), donors and donation: donor evaluation, graft survival, lung transplantation / pulmonology",
author = "Swanson, {Elizabeth A.} and Patel, {Madhukar S.} and Michael Hutchens and Niemann, {Claus U.} and Tahnee Groat and Malinoski, {Darren J.} and Mitchell Sally",
note = "Funding Information: The authors acknowledge and thank the donors, recipients, staff, and leadership of the following Organ Procurement Organizations for their support of this study, as well as their assistance in collection and management of data: Donor Network of Arizona, California Transplant Donor Network, Golden State Donor Services, OneLegacy, New Mexico Donor Services, Nevada Donor Network, DonorConnect, Lifesharing – A Donate Life Organization, LifeGift, Pacific Northwest Transplant Bank, Gift of Life Michigan, LifeLink of Georgia, Gift of Hope, New England Organ Bank, Southwest Transplant Alliance, Tennessee Donor Services, and Donor Alliance. This work was supported by Arnold Ventures and by the Health Resources and Services Administration (R38 OT22183). Dr Swanson received support from the National Institute of Diabetes and Digestive and Kidney Diseases (F30 DK114980) and Dr Hutchens received support from the Veterans Administration (I01BX004288). Funding Information: The authors acknowledge and thank the donors, recipients, staff, and leadership of the following Organ Procurement Organizations for their support of this study, as well as their assistance in collection and management of data: Donor Network of Arizona, California Transplant Donor Network, Golden State Donor Services, OneLegacy, New Mexico Donor Services, Nevada Donor Network, DonorConnect, Lifesharing ? A Donate Life Organization, LifeGift, Pacific Northwest Transplant Bank, Gift of Life Michigan, LifeLink of Georgia, Gift of Hope, New England Organ Bank, Southwest Transplant Alliance, Tennessee Donor Services, and Donor Alliance. This work was supported by Arnold Ventures and by the Health Resources and Services Administration (R38 OT22183). Dr Swanson received support from the National Institute of Diabetes and Digestive and Kidney Diseases (F30 DK114980) and Dr Hutchens received support from the Veterans Administration (I01BX004288). Publisher Copyright: {\textcopyright} 2021 The American Society of Transplantation and the American Society of Transplant Surgeons.",
year = "2021",
month = dec,
doi = "10.1111/ajt.16719",
language = "English (US)",
volume = "21",
pages = "4003--4011",
journal = "American Journal of Transplantation",
issn = "1600-6135",
publisher = "Wiley-Blackwell",
number = "12",
}