Airway pressure release ventilation forin-vivodonor lung management and lung transplant outcomes

Background:Airway pressure release ventilation(APRV)can be used for cadaveric donor lung recruitment.APRV elevates PaO_(2)in donor lungs;however,reported outcomes in recipients with APRVmanaged donor lungs are limited.Methods:We retrospectively reviewed patients who underwent lung transplantation(LTx)from 2012 to 2013 and divided them into two groups based on mode of ventilation used during donor management and organ extraction(A:non-APRV;B:APRV).Kaplan-Meier method and multivariate Cox regression were used for analysis.Results:We found 126 LTx recipients(LTxRs);9 were excluded for use of portable ventilation perfusion systems.Of the remaining 117 patients,81(69%)were in Group A;36(31%)were in Group B.Preoperative LTxR characteristics(age,sex,lung allocation score,endstage lung disease type)were comparable between groups.Donors for Group B were older(P=0.03)and had higher body mass index(BMI)(P<0.001),higher incidence of death from chest trauma(P=0.008),longer ventilation duration after brain death(P<0.001),and higher pre-explant PaO_(2)/FiO_(2)ratios(P<0.001).Post-LTx duration of mechanical ventilation,hospital stay,and median survival were similar in both groups.Risk of death was comparable between the two groups at the end of follow-up(HR=1.42;95%CI:0.57-3.56;P=0.45).Conclusions:APRV is a safe and effective pre-LTx donor lung management strategy.Short-and long-term survival outcomes were comparable in LTx recipients,irrespective of donor ventilation mode.APRV may help recruit lungs from older donors with higher BMI who die from chest trauma and have anticipated longer ventilation duration.