Outcomes of extended donor lung recipients after lung transplantation.
BACKGROUND
Lung transplantation is currently limited by the number of suitable donor organs. Many lung-transplant programs use lungs that do not meet the formal criteria for acceptability; however, the immediate and long-term consequences of this approach remain unclear.


METHODS
We performed a retrospective cohort study of all patients who underwent lung transplantation at the Columbia University Medical Center from July 2001 to July 2003. We assessed the outcomes of recipients of extended donor lungs compared with those of recipients of optimal donor lungs after adjusting for confounding variables.


RESULTS
Fifty-one patients underwent lung transplantation, of which 27 (53%) received extended donor lungs. Recipients of extended donor lungs had fewer intensive care unit-free days at 30 days (P=0.002) and a longer time to hospital discharge (P=0.007) than did recipients of optimal donor lungs. Extended donor recipients also had lower forced expiratory volume in 1 second % predicted at 1 year than did optimal donor recipients (P=0.03). There were no differences in the 30-day or longer-term survival of extended and optimal donor lung recipients.


CONCLUSIONS
Recipients of extended donor lungs have a longer intensive care unit course, a prolonged hospital stay, and lower pulmonary function at 1 year than recipients of optimal lungs. Despite these differences, survival is similar between the two groups. The criteria for the optimal lung donor should be re-evaluated considering the current shortage of acceptable organs. Although some outcomes may differ with the use of extended donor lungs, the clinical impact of these differences should be assessed in future prospective multicenter studies.
Kawut
Steven M
SM
Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA. sk2097@columbia.edu
Reyentovich
Alexander
A
Wilt
Jessie S
JS
Anzeck
Roberto
R
Lederer
David J
DJ
O'Shea
Mitchell K
MK
Sonett
Joshua R
JR
Arcasoy
Selim M
SM
D000328:Adult; D005260:Female; D006801:Humans; D007902:Length of Stay; D016040:Lung Transplantation / Q000401:mortality / Q000502:physiology*; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D044469:Racial Groups; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D012907:Smoking; D016019:Survival Analysis; D014019:Tissue Donors / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014481:United States