Extended donor criteria for lung transplantation--a clinical reality.
OBJECTIVE
Standard lung donor criteria have been established on opinions and individual experiences rather than on existing evidence. Since the scarcity of donor organs is one of the major limitations to lung transplantation, extension of donor lung criteria might considerably increase the donor pool. This study therefore evaluates the outcome, achieved with the use of extended donors versus standard donors and aims to redefine lung donor criteria.


METHODS
We performed a retrospective analysis of 98 consecutive primary lung transplantations from 94 donors from 1/2001 to 12/2002. Donors were classified as extended if they fulfilled at least one criteria: age >55 years, PaO(2) at FiO(2)/PEEP 5 <300mmHg, tobacco history >20 pack years, inhalative drug abuse, presence of infiltration on chest X-ray or purulent secretions at bronchoscopy. Recipients were stratified in two groups according to whether they received a 'standard' or 'extended' organ. Postoperative complications, extubation time, ICU and hospital stay and survival were compared.


RESULTS
Twenty-three (24.5%) donors were extended. Twenty-six recipients (26.55%) received organs from extended donors. Differences in intubation times (12+/-2 days standard vs. 14+/-5 days extended, P=0.70), ICU stay (16+/-2 days standard vs. 18+/-5 days extended, P=0.74) and hospital stay (38+/-4 days standard vs. 40+/-6 days extended, P=0.71) were not statistically significant. Postoperative bleeding rates were comparable (n=14 standard vs. n=3 extended) as well as bronchial anastomotic complications (n=7 standard vs. n=3 extended). Three months survival was 88.89% in the standard group vs. 92.31% in the extended group. One year survival is comparable as well with 81.94 vs. 84.62%, respectively.


CONCLUSIONS
The use of lung donors who fail to meet standard criteria does not impair short and medium term results compared to standard lung donors. The impact on long term development of BOS has yet to be evaluated. The strict application of standard lung donor criteria excludes a considerable number of lungs potentially suitable for transplantation, thus liberalisation of donor criteria might help to overcome donor shortage.
Aigner
Clemens
C
Department of Cardiothoracic Surgery, Vienna Medical University, Waehringer Guertel 18-20, 1090 Vienna, Austria.
Winkler
Guenther
G
Jaksch
Peter
P
Seebacher
Gernot
G
Lang
Gyorgy
G
Taghavi
Sharokh
S
Wisser
Wilfried
W
Klepetko
Walter
W
D000328:Adult; D000367:Age Factors; D046148:Donor Selection / Q000379:methods / Q000592:standards*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008168:Lung / Q000473:pathology / Q000503:physiopathology; D008171:Lung Diseases / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D012907:Smoking; D019966:Substance-Related Disorders; D014019:Tissue Donors; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome