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J Thorac Cardiovasc Surg 2002;123:429-436
© 2002 The American Association for Thoracic Surgery

Cardiothoracic Transplantation (TX)

Does donor cause of death affect the outcome of lung transplantation?

From the Division of Cardiothoracic Surgery, Department of Surgery,^a and Division of Pulmonary Medicine, Department of Internal Medicine,^b Washington University School of Medicine, St Louis, Mo.

Received for publication May 14, 2001; revisions requested July 10, 2001; revisions received Sept 5, 2001; accepted for publication Sept 13, 2001. Address for reprints: G. Alexander Patterson, MD, One Barnes-Jewish Plaza, 3108 Queeny Tower, St Louis, MO 63110 (E-mail: Pattersona{at}msnotes.wustl.edu).

Background: Accumulating evidence suggests that the donor's cause of death may influence posttransplantation allograft function. We conducted a retrospective analysis of our adult lung transplant experience to investigate the influence of donor traumatic brain injury versus nontraumatic brain injury on posttransplantation outcome.
Methods: We retrospectively reviewed donor records and recipient medical charts for 500 consecutive lung transplants performed between July 1988 and December 1999. Recipient follow-up was complete, with a minimum follow-up of 1 year of survival.
Results: There were 295 and 205 donors in the traumatic and nontraumatic brain injury groups, respectively. Young male donors predominated in the traumatic brain injury group. Recipients receiving donor lungs from the traumatic and nontraumatic brain injury groups did not differ by age, sex, diagnosis, type of transplant (single-lung versus double-lung) or requirement for pretransplantation mechanical ventilatory assistance. Recipients did not differ in immediate or 24-hour PaO₂/inspired oxygen ratio, ventilation time, hospital stay, hospital mortality, or overall survival. Recipients of organs from donors who died of traumatic brain injury showed a higher severity and frequency of rejection episodes during the first year after transplantation. Freedoms from bronchiolitis obliterans syndrome at 5 years were 34.5% and 50.8% for recipients of organs from donors who died of traumatic and nontraumatic brain injury, respectively (P = .002).
Conclusions: The cause of donor brain death does not appear to influence early results of lung transplantation. Traumatic brain injury, or some phenomenon associated with it, may predispose a transplanted lung and its recipient toward more severe early rejection episodes and subsequent development of bronchiolitis obliterans syndrome.

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