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Right arrow Lung - transplantation

J Thorac Cardiovasc Surg 2006;131:1154-1160
© 2006 The American Association for Thoracic Surgery

Cardiothoracic Transplantation

Extended donor criteria in lung transplantation: Impact on organ allocation

Phil Botha, MRCS a , * , Dipesh Trivedi, FRCS a , Christopher J. Weir, PhD b , Cait P. Searl, FRCA a , Paul A. Corris, FRCP c , John H. Dark, FRCS a , Stephan V.B. Schueler, FRCS a

a Department of Cardio-pulmonary Transplantation, Freeman Hospital, Newcastle upon Tyne, United Kingdom
b Robertson Centre for Biostatistics, University of Glasgow, Glasgow, United Kingdom
c Immunology and Transplantation Research Group, University of Newcastle upon Tyne, Newcastle upon Tyne, United Kingdom

Received for publication September 16, 2005; revisions received November 25, 2005; accepted for publication December 9, 2005.

* Address for reprints: Phil Botha, MRCS, Department of Cardiopulmonary Transplantation Freeman Hospital, High Heaton, Newcastle upon Tyne, NE7 7DN, United Kingdom (Email: P.Botha{at}ncl.ac.uk).

OBJECTIVE: Some reports have documented a higher early mortality with the use of extended criteria donors in lung transplantation. None have evaluated how outcomes compare with the use of these organs for single and bilateral transplantation or whether this practice results in a higher incidence of early bronchiolitis obliterans syndrome.

METHODS: We performed a retrospective review of case notes, intensive therapy unit database, and donor details. Between January 1, 2000, and December 31, 2004, 201 patients underwent lung or heart-lung transplantation.

RESULTS: Eighty-three (41.3%) patients received organs deemed marginal on the basis of at least one of the following criteria: donor age greater than 55 years, duration of ventilation greater than 5 days, purulent secretions or inflammation at bronchoscopy, smoking of 20 or more cigarettes per day, abnormality on chest roentgenogram, or PO 2/fraction of inspired oxygen ratio of less than 300 mm Hg immediately before donor organ procurement. Recipients of marginal lungs had a higher incidence of severe (grade 3) primary graft dysfunction (43.9% vs 27.4%, P = .015) and 90-day organ-specific mortality (15.7% vs 5.1%, P = .012). Bilateral transplantation carried a significantly higher 30-day mortality if performed with marginal organs (17.0% vs 2.7% with standard donor organs, P = .005). Thirty-day mortality was not significantly different for the transplantation of single marginal or standard donor lungs. Cumulative survival and survival free of bronchiolitis obliterans syndrome was not affected by marginal donor status.

CONCLUSION: Transplantation of extended criteria donor lungs leads to a higher incidence of primary graft dysfunction. Bilateral transplantation with these organs seems to confer less reserve, resulting in a higher early mortality rate. Medium-term functional outcome is, however, not adversely affected by the relaxation of donor criteria.

Abbreviations and Acronyms BLT = bilateral lung transplantation; BOS = bronchiolitis obliterans syndrome; CPB = cardiopulmonary bypass; CXR = chest roentgenogram; FIO 2 = fraction of inspired oxygen; ITU = intensive therapy unit; PGD = primary graft dysfunction; SLT = single lung transplantation




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