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J Thorac Cardiovasc Surg 1995;109:1075-1080
© 1995 Mosby, Inc.
CARDIAC AND PULMONARY REPLACEMENT |
St. Louis, Mo.
From the Division of Cardiothoracic Surgery, Department of Surgery,a Mallinckrodt Institute of Radiology,b and Respiratory andCritical Care Division, Department of Medicine,c WashingtonUniversity School of Medicine, Barnes Hospital, St. Louis, Mo.
Address for reprints: Sudhir Sundaresan, MD, Division of CardiothoracicSurgery, Suite 3107 Queeny Tower, One Barnes Hospital Plaza, St. Louis, MO63110.
Abstract
Lung transplantation is limited by a shortage ofsuitable donors. To address this shortage, we have begun using donor lungsthat do not meet all of our previous rigorous donor criteria. Of 133 consecutivelung transplants done between June 1991 and March 1994, 89 donors were consideredideal because they satisfied all of the following accepted donor criteria(group I): age younger than 55 years, smoking less than 20 pack-years, arterialoxygen tension greater than 300 mm Hg (using inspired oxygen fraction of 1.0and positive end-expiratory pressure 5 cm H2O), and chest radiographnegative for infiltrate or trauma (contusion or pneumothorax). Thirty-sevendonors failed to satisfy one of these criteria and seven donors failed tosatisfy two of them, yielding 51 criteria denoting marginal status in the44 donors in the marginal group (group II) as follows: age older than 55 years,2; smoking history 20 or more pack-years, 9; unsatisfactory chest radiograph,34; and arterial oxygen tension less than 300 mm Hg, 6. Sixty-three singlelung transplants were done (group I, 44 versus group II, 19) compared with70 bilateral sequential transplants (group I, 45 versus group II, 25). In24 cases in group II, at least one of the lungs actually being implanted containedcontusion or infiltrate. Evaluation of recipients from the two groups showedno significant difference in median duration of postoperative mechanical ventilation(3 days in both group I and group II) nor in alveolar-arterial oxygen gradientimmediately after transplantation (group I, 304 ± 14 mm Hg versus groupII, 275 ± 22 mm Hg; p = 0.266) or at24 hours (group I, 125 ± 12 mm Hg versus group II, 122 ± 18mm Hg; p = 0.933) (all values represent meanplus or minus the standard error). However, cardiopulmonary bypass was requiredto facilitate second graft insertion in bilateral sequential transplants moreoften in the marginal group (5 of 25, 20%) than in group I (6 of 45, 13%).There were three deaths within 30 days in group I (operative mortality, 3.4%)and none in group II. Currently, 74 (83.2%) of 89 remain alive in group Icompared with 38 (86.4%) of 44 in group II. On the basis of these data, weconclude that successful outcome of lung transplantation can be achieved withthe use of marginal donor lungs. (J THORACCARDIOVASC SURG1995;109:1075-80)
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