Donation after Circulatory Death Donors Are Associated With Increased 1‐Year Mortality After Lung Transplantation: A UNOS‐Based Risk Stratification Study

Background The use of donation after circulatory death (DCD) donors has significantly increased in recent years. The current study sought to risk‐stratify transplants where DCD donors are utilized. Methods We reviewed the UNOS database for adult patients who underwent lung transplantation (LT) using DCD donors between 2017 and 2022 ( n = 948, 6.31% of all LT). One‐year mortality was the primary dependent variable. Results The proportion of DCD donors is increasing (3.7% in 2017 to 7.6% in 2022, p < 0.001) and is associated with significantly higher 1‐year mortality (13.9% vs. 10.7% among recipients of brain dead donors; p = 0.003). On Cox proportional hazard analysis with bootstrap validation, recipient age > 65 years (adjusted hazards ratio, 95% CI: 1.51, 1.05–2.2; p = 0.028), admission to the ICU at the time of transplant (2.11, 1.34–3.31; p = 0.001), estimated GFR < 75 mL/min/1.73 m 2 at the time of transplant (1.81, 1.23–2.67; p = 0.003), and organ out of body time >7 h (2.02, 1.39–2.94; p < 0.001) are associated with 1‐year mortality. A composite variable, the recipient risk score, based on the number of above risk factors, is strongly associated with 1‐year mortality. Conclusions The utilization of DCD donors is associated with worse 1‐year mortality after LT. The recipient risk score based on the four simple‐to‐use recipient and procedure‐related variables strongly predicts outcomes.