Outcomes of patients awaiting lung transplantation after the implementation of donation after brain death at a single Chinese center

Abstract

Voluntary contribution has become the only source of donor lungs in China since 2015. To elaborate the outcomes of patients awaiting lung transplantation (LTx) after the implementation of donation after brain death, we performed a retrospective study that encompassed 205 patients with end-stage lung disease who registered for LTx at Shanghai Pulmonary Hospital from January 1, 2015 to January 1, 2021. A total of 180 patients were enrolled in the study. The median waiting time was 1.25 months. Interstitial lung disease (ILD) (103/180, 57.2%) and chronic obstructive pulmonary disease (COPD) (56/180, 31.1%) were the most common diseases in our study population. The mean pulmonary artery pressure (mPAP) of patients in the died-waiting group was higher than that of the survivors (53.29±21.71 mmHg vs. 42.11±18.58 mmHg, P=0.002). The mortality of patients with ILD (34/103, 33.00%) was nearly twice that of patients with COPD (10/56, 17.86%) while awaiting LTx (P=0.041). In the died-waiting group, patients with ILD had a shorter median waiting time than patients with COPD after being listed (0.865 months vs. 4.720 months, P=0.030). ILD as primary disease and mPAP > 35 mmHg were two significant independent risk factors for waitlist mortality, with hazard ratios (HR) of 3.483 (95% CI 1.311–9.111; P=0.011) and 3.500 (95% CI 1.435–8.536; P=0.006). Hence, LTx is more urgently needed in patients with ILD and pulmonary hypertension.

Keywords

lung transplantation / donation after brain death / waitlist

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Acknowledgements

This work was supported by the grants from the National Natural Science Foundation of China (Nos. 81100061 and 81670089), the Shanghai Municipal Commission of Health and Family Planning (No. 201640225), the Science and Technology Commission of Shanghai Municipality (No. 19411964100), and the Startup Fund for scientific research, Fujian Medical University (No. 2019QH1278).

Compliance with ethics guidelines

Yuling Yang, Xinnan Xu, Ming Liu, Yanfeng Zhao, Yongmei Yu, Xiaogang Liu, Chang Chen, Gening Jiang, and Wenxin He declared no conflicts of interest. This study was approved by the Ethics Committee of the Shanghai Pulmonary Hospital of Tongji University.

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