Lung Transplant Outcomes in Donors Managed with Airway Pressure Release Ventilation

Abstract

Purpose: Airway pressure release ventilation (APRV), a pressure-control type of mechanical ventilation, is used for lung recruitment in cadaveric donor lungs. APRV elevates PaO2 in donor lungs, but clinical outcomes in transplant recipients with APRV-managed donor lungs are unreported. Methods: We retrospectively reviewed patients who underwent lung transplantation (LTx) from 2012 to 2013. Patients were divided into 2 groups based on mode of ventilation used during donor management and organ extraction (Group A, non-APRV; Group B, APRV). Probability of survival at 90 days, 1 year, and 3 years was analyzed using Kaplan-Meier estimates. Multivariate Cox regression was used to calculate adjusted risk of survival. Results: Of the 126 LTx (with cadaveric donors) performed during the study period, 9 recipients were excluded because their donors' lungs were maintained on portable ventilation perfusion systems. Of the remaining 117 patients, 81 (69%) were in Group A; 36 (31%) were in Group B. Baseline characteristics (e.g., preoperative recipient characteristics [age, sex, lung allocation score, type of end-stage lung disease]) were comparable between groups. Donors for Group B recipients were older (p= 0.03) and had higher body mass index (p< 0.001), higher incidence of chest trauma (p= 0.008), longer duration of ventilation after brain death (p< 0.001), and higher preexplant PaO2/FiO2 ratios (p< 0.001). After LTx, mechanical ventilation duration, postoperative length of stay, and median survival were similar in both groups. A Cox regression model showed comparable risk of death in both groups over 3 years (HR= 0.83, 95% CI 0.43, 1.62). Conclusion: APRV is an effective pre-LTx donor lung management strategy. Despite older donors with longer ventilation times, pre-explant PaO2/FiO2 ratios were still better in donors with APRV than without. Short-and long-term survival outcomes were comparable in LTx recipients at our center regardless of ventilation mode. Larger multi-center studies would likely validate these data (Figure presented).