Effect of Lung Protective Ventilation in Organ Donors on Lung Procurement and Recipient Survival

Previous studies have shown that a lung protective strategy in selected potential organ donors after brain death increased lung eligibility and procurement. This prospective nationwide cohort study aimed to evaluate the impact of lung protective ventilation (PV) in non-selected donors on lung procurement and recipient survival after lung transplantation. We included all reported donors after brain death aged 18 to 70 years without a lung recovery contraindication and with at least one organ recovered between January 2016 and December 2017. PV was defined as tidal volume ≤ 8 ml/kg predicted body weight and positive end expiratory pressure ≥ 8 cm H2O. The association between PV at the time of lung proposal (T1) and lung procurement was determined by multivariable logistic regression stratified by propensity score quintile to account for PV and non-PV group differences in baseline characteristics. We studied 1-year survival of recipients from donors with or without PV at T1. Of 1,626 included lung donors, 1,109 (68%) had at least one lung proposed; 678 (61%) of these had at least one lung recovered. For donors with a lung proposal, the probability of lung procurement was increased with PV at T1 (OR 1.43, 95% CI 1.03-1.98, p=0.03). One-year survival did not differ between recipients of lungs from donors with and without PV (82.7%, 95% CI 76.0-87.8% vs 82.3%, 95% CI 78.5-85.4%, p=0.94). The use of lung PV in non-selected donors may increase lung procurement. One-year survival did not differ between recipients of lungs from donors with or without PV.