Changes in radiographic abnormalities in organ donors: associations with lung transplantation.
BACKGROUND
Only 20% of organ donors are considered suitable for lung transplantation. No extensive study exists that has evaluated changes in thoracic radiographic abnormalities in organ donors. The purpose of this study was to determine the impact of radiographic abnormalities on successful transplantation.


METHODS
In a retrospective survey of 110 organ donors, chest radiographs (N = 417) taken during the initial 24 hours after admission and just before organ harvest were evaluated for 9 radiographic criteria, radiographic diagnoses and clinical characteristics and their association with lung transplantation.


RESULTS
Initial lung densities were present in 37% of lungs; there were bilateral infiltrates in 25% of cases. During evaluation (69.7 +/- 60 hours), 38% of right lungs and 28% of left lungs improved radiographically. Up to 51% of lungs with initial infiltrates resolved completely. Worsening of lung infiltrates was more common in the non-transplant group (p = 0.02); however, improvement in densities was not associated with transplantation (p = 0.6). Multivariate analysis determined that moderate and severe lung densities (OR 7.68, p = 0.01; OR 10.8, p = 0.004) and bilateral infiltrates (OR 4.79, p = 0.02) were independent predictors of rejection for transplantation. With densities removed from the model, the number of abnormal diagnoses on the final films was an independent predictor of rejection for transplantation (OR 3.23, p = 0.003).


CONCLUSIONS
More than 33% of proposed organ donors initially have lung infiltrates, with >33% showing improvement or resolution, but this improvement does not impact on procurement. Multiple abnormal radiographic diagnoses also contribute to transplant rejection.
McCowin
Marcia J
MJ
Department of Radiology, University of California, San Francisco, San Francisco, CA, USA.
Hall
Timothy S
TS
Babcock
Wayne D
WD
Solinger
Lisa L
LL
Hall
Katherine W
KW
Jablons
David M
DM
D000328:Adult; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology*; D006801:Humans; D016015:Logistic Models; D008168:Lung / Q000000981:diagnostic imaging*; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D010996:Pleural Effusion / Q000209:etiology; D011654:Pulmonary Edema / Q000209:etiology; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors; D014019:Tissue Donors