*Purpose: This study seeks to help expand the lung transplant donor pool by demonstrating the safe use of lung allografts from donors who underwent pre-procurement cardiac arrest (PPCA) in the hopes of lowering the high waitlist mortality in lung transplantation.

*Methods: This study is a retrospective analysis of 278 lung transplant recipients at a single center from 2013 to 2018. Donor demographics, cause of death, and signs of early lung injury were determined by reviewing original medical records as well as records from the United Network of Organ Sharing. Recipient hospital records were extracted to review recipient demographics and clinical outcomes.

*Results: Of the 278 lung transplant recipients included in this study, 120 received lung allografts from donors who experienced PPCA. Donors who underwent PPCA were more likely to have a history of tobacco abuse (p = 0.001) and were more likely to be smoking at the time of procurement (p = 0.007). There were no significant differences in recipient demographics or intraoperative variables between the two groups. In regard to short-term clinical outcomes, the PPCA group demonstrated shorter median time spent on mechanical ventilation (p < 0.01), shorter initial hospital stays (p = 0.05), lower rates of postoperative tracheostomy (p < 0.01), and a lower chance to be on extracorporeal membrane oxygenation for greater than 48 hours (p = 0.04). When comparing the survival of the two groups, recipients with PPCA allografts had better survival at 1-year post-transplant (p = 0.04), but there was no significant difference in survival at 3-years (p = 0.97) and 5-years (p = 0.64). Additionally, Kaplan-Meier analysis showed no difference in mortality between the two groups (p = 0.35).

*Conclusions: PPCA in the donor does not lead to worse clinical outcomes in lung transplant recipients. Select short-term clinical outcomes and 1-year survival were better in recipients of PPCA donor allografts, and long-term outcomes showed no significant difference between the two groups. Based on the results of this study, lung allografts from donors who suffered PPCA should not be regarded as inherently inferior as they can be used to provide equivalent clinical outcomes in recipients when compared to other donor allografts.

« Back to 2021 American Transplant Congress