Clinical lung transplantation from uncontrolled non-heart-beating donors revisited.
BACKGROUND
The aim of our study is to review and update the long-term results from our previously published series of lung transplantation in uncontrolled non-heart-beating donors (NHBDs).


METHODS
A prospective collection of data was undertaken from all lung transplants performed among uncontrolled NHBDs between 2002 and December 2009. The statistical analysis was performed using SPSS software and survival was estimated using the Kaplan-Meier method.


RESULTS
Twenty-nine lung transplants were performed. Mean total ischemic times for the first and second lung were 575 minutes (SD 115.6) and 701 minutes (SD 111.3), respectively. Primary graft dysfunction (PGD) G1, G2 and G3 occurred in 5 cases (17%), 5 cases (17%) and 11 cases (38%), respectively. Overall hospital mortality rate was 17% (5 patients). Statistical analysis revealed a statistically significant association of mortality with ischemic times and with PGD. In terms of overall survival, 3-month, 1-year, 2-year and 5-year survival rates were 78%, 68%, 57% and 51%, respectively, and the conditional survival rates in those who survived the first 3 months were 86%, 72% and 65%, respectively. The cumulative incidence of bronchiolitis obliterans syndrome (BOS) was 11%, 35% and 45% at 1, 3 and 5 years, respectively.


CONCLUSIONS
Lung transplantation from uncontrolled non-heart-beating donors shows acceptable results for both mid- and long-term survival and BOS; however, the higher rates of PGD and its impact on early mortality must make us more demanding with respect to the acceptance criteria and methods of evaluation used with these donors.
Department of Thoracic Surgery, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain. dgavm@yahoo.es
David
D
Gomez-de-Antonio
Jose Luis
JL
Campo-Cañaveral
Silvana
S
Crowley
Daniel
D
Valdivia
Mar
M
Cordoba
Javier
J
Moradiellos
Jose Manual
JM
Naranjo
Piedad
P
Ussetti
Andrés
A
Varela
D000328:Adult; D001987:Bronchiectasis / Q000401:mortality / Q000601:surgery; D004646:Emphysema / Q000401:mortality / Q000601:surgery; D005260:Female; D006085:Graft Survival; D006323:Heart Arrest; D006801:Humans; D053208:Kaplan-Meier Estimate; D016040:Lung Transplantation / Q000592:standards*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D055031:Primary Graft Dysfunction / Q000453:epidemiology*; D011446:Prospective Studies; D011658:Pulmonary Fibrosis / Q000401:mortality / Q000601:surgery; D012189:Retrospective Studies; D015996:Survival Rate; D014019:Tissue Donors; D016896:Treatment Outcome