RESUMO
OBJECTIVES: Competing requirements for organ perfusion may call for antagonistic strategies such as fluid replacement or high positive end-expiratory pressure. We recently proposed an intensive lung donor treatment protocol that nearly tripled lung procurement rates and validated it in a multicentre study. The next step was to evaluate the impact of our proposal on the other organ grafts recovered from lung donors and on the recipients' outcome after transplantation of those grafts. METHODS: A quasi-experimental study was conducted in six Spanish hospitals during 2013 (2010-12 was historical control). Organ donor management was led by a trained and experienced intensive care staff. RESULTS: A total of 618 actual donors after brain death (DBDs) were included, 453 DBDs in the control period (annual average 151) and 165 in the protocol period. No baseline differences were found between the periods. Heart, liver, kidney and pancreas retrieval rates were similar in both periods, and heart, liver, kidney and pancreas recipients' survival at 3 months showed no differences between both periods. CONCLUSIONS: Our lung donor treatment protocol is safe for other grafts obtained from donors undergoing these procedures with the aim of increasing lungs available for transplantation. It has no negative impact on the recovery rates of other grafts or on early survival of heart, liver, pancreas or kidney recipients.
Assuntos
Protocolos Clínicos , Transplante de Pulmão/estatística & dados numéricos , Obtenção de Tecidos e Órgãos/métodos , Adulto , Idoso , Morte Encefálica , Feminino , Sobrevivência de Enxerto , Humanos , Transplante de Pulmão/mortalidade , Masculino , Pessoa de Meia-Idade , Transplante de Órgãos/mortalidade , Transplante de Órgãos/estatística & dados numéricos , Espanha/epidemiologia , Doadores de Tecidos , Obtenção de Tecidos e Órgãos/normas , Obtenção de Tecidos e Órgãos/estatística & dados numéricosRESUMO
BACKGROUND: The shortage of lung donors for transplantation is the main limitation among patients awaiting this type of surgery. We previously demonstrated that an intensive lung donor-treatment protocol succeeded in increasing the lung procurement rate. We aimed to validate our protocol for centers with or without lung transplant programs. METHODS: A quasi-experimental study was performed to compare lung donor rate before (historical group, 2010 to 2012) and after (prospective group, 2013) the application of a lung management protocol for donors after brain death (DBDs) in six Spanish hospitals. Lung donor selection criteria remained unchanged in both periods. Outcome measures for lung recipients were early survival and primary graft dysfunction (PGD) rates. RESULTS: A total of 618 DBDs were included: 453 in the control period and 165 in the protocol period. Donor baseline characteristics were similar in both periods. Lung donation rate in the prospective group was 27.3%, more than twice that of the historical group (13%; p < 0.001). The number of lungs retrieved, grafts transplanted, and transplants performed more than doubled over the study period. No differences in early recipients' survival between groups were observed (87.6% vs. 84.5%; p = 0.733) nor in the rate of PGD. CONCLUSION: Implementing our intensive lung donor-treatment protocol increases lung procurement rates. This allows more lung transplants to be performed without detriment to either early survival or PGD rate.