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Right arrow Lung - transplantation

J Thorac Cardiovasc Surg 2002;123:421-428
© 2002 The American Association for Thoracic Surgery

Cardiothoracic Transplantation (TX)

Marginal donor lungs: A reassessment

Andrew F. Pierre, MD, MSc, FRCSC, Yasuo Sekine, MD, Michael A. Hutcheon, MD, FRCPC, Thomas K. Waddell, MD, MSc, PhD, FRCSC, Shaf H. Keshavjee, MD, MSc, FRCSC, FACS

From the Toronto Lung Transplant Program, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.

Received for publication May 14, 2001; revisions requested July 11, 2001; revisions received Sept 7, 2001. Accepted for publication Sept 14, 2001. Address for reprints: Shaf H. Keshavjee, MD, Director, Toronto Lung Transplant Program, Division of Thoracic Surgery, Toronto General Hospital, 200 Elizabeth St, EN 10-224, Toronto, Ontario M5G 2C4, Canada (E-mail: shaf.keshavjee{at}uhn.on.ca).

Objective: Lung transplantation is limited by the shortage of suitable donors. To overcome this problem, many programs have begun to use marginal or extended donors after reports suggesting equivalent outcomes with no additional risk. As our use of extended donor lungs increased and our recipient selection criteria expanded, we believed it was appropriate to reevaluate outcomes with extended donor lungs compared with outcomes with standard donor lungs and recipients outside of the currently accepted guidelines.
Methods: We performed a retrospective review of 128 consecutive lung or heart-lung transplants from January 1, 1997, to June 30, 2000. The primary endpoint was 30-day mortality. Donors were considered extended if any one of the following criteria were met: age greater than 55 years, smoking longer than 20 pack-years, presence of chest radiographic film infiltrate, PO2 of less than 300 mm Hg, or purulent secretions on bronchoscopy. Guideline and nonguideline recipients were defined on the basis of previously published criteria.
Results: Of a total of 123 donors, 63 (51%) were extended. Forty-eight donors failed 1 criterion, 10 failed 2 criteria, and 5 failed 3 criteria. One hundred twenty-eight transplants were performed. The 30-day mortality for the standard donor group was 4 (6.2%) of 65 versus 11 (17.5%) of 63 for the extended donor group (P = .047).
Conclusions: Although many extended donor lungs will result in acceptable postoperative function, caution needs to be exercised in the uses of certain extended donor lungs because there seems to be an increased early mortality rate in that group of recipients. Nonguideline recipients appear to have acceptable early mortality, except when they received extended donor lungs.




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