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The Comparable Efficacy of Lung Donation After Circulatory Death and Brain Death

A Systematic Review and Meta-analysis

Zhou, Jian MD1,2; Chen, Boran MD2; Liao, Hu MD1,3; Wang, Zihuai MD1,2; Lyu, Mengyuan MD2; Man, Shulei MD2; Pu, Qiang MD1,3; Liu, Lunxu MD, PhD1,3

doi: 10.1097/TP.0000000000002888
Original Clinical Science—General

Background. Lung transplantations (LTx) have become an effective lifesaving treatment for patients with end-stage lung diseases. While the shortage of lung donor pool and severe posttransplantation complications exaggerate the obstacle of LTx. This meta-analysis aimed to evaluate the efficacy of donation after circulatory death (DCD) in LTx for patients with end-stage lung diseases.

Methods. PubMed, EmBase, and Web of Science were systematically searched for all relevant studies comparing the efficacy of DCD and conventional donation after brain death (DBD). The relative risk (RR) value as well as the weighted mean difference with a 95% confidence interval (CI) were pooled for dichotomous and continuous outcomes, respectively. The heterogeneity across the included studies was also assessed carefully.

Results. Overall, 17 studies with 995 DCD recipients and 38 579 DBD recipients were included. The pooled analysis showed comparable 1-year overall survival between the 2 cohorts (RR 0.89, 95% CI, 0.74-1.07, P = 0.536, I2 = 0%). The airway anastomotic complications rate in DCD cohort was higher than that in DBD cohorts (RR 2.00; 95% CI, 1.29-3.11, P = 0.002, I2 = 0%). There was no significant difference between DCD and DBD regarding the occurrence of primary graft dysfunction grade 2/3, bronchiolitis obliterans syndrome, acute transplantation rejection, and length of stay. The stability of the included studies was strong.

Conclusions. Evidence of this meta-analysis indicated that the use of lungs from DCD donors could effectively and safely expand the donor pool and therefore alleviate the crisis of organ shortage.

1 Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.

2 West China School of Medicine, Sichuan University, Chengdu, China.

3 Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, China.

Received 17 February 2019. Revision received 3 July 2019.

Accepted 4 July 2019.

J.Z. and B.C. contributed equally.

The authors declare no conflicts of interest.

J.Z. and L.L. participated in conception and design. L.L. performed administrative support. J.Z. and B.C. participated in provision of study materials or patients, and data analysis and interpretation. H.L., M.L., Z.W., S.M., and Q.P. performed collection and assembly of data. All authors performed manuscript writing and final approval of manuscript.

This work was supported by Key Science and Technology Program of Sichuan Province, China (2016FZ0118) (to Dr Lunxu Liu).

Supplemental digital content (SDC) is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (

Correspondence: Lunxu Liu, MD, PhD, Department of Thoracic Surgery, West China Hospital, Sichuan University, No 37, Guoxue Alley, Chengdu, Sichuan 610041, China. (

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