title: Double-lung transplantation can be safely performed using donors with heavy smoking history.
abstract: BACKGROUND
  Lung transplantation using grafts from donors with a history of heavy smoking (>20 pack-years) is thought to confer worse prognosis. We attempt to determine if adult, double-lung transplantation can be safely performed with lungs from heavy-smoking donors (HSD).
  
  
  METHODS
  The United Network for Organ Sharing (UNOS) database was examined for adult, double-lung transplants from 2005 to 2011.
  
  
  RESULTS
  Of 5,900 double-lung transplants, 766 (13.0%) were from HSDs. The two groups were similar in recipient age (49.8 vs 50.5 years, p = 0.15), male sex (56.9% vs 56.5%, p = 0.87), and lung allocation score (45.8 vs 44.9, p = 0.18). Recipients of lungs from HSDs had lower forced expiratory volume in 1 second (FEV1; 34.3 vs 36.1% predicted, p = 0.04), longer ischemic time (5.75 vs 5.58 hours, p = 0.01), less human leukocyte antigen mismatch (4.51 vs 4.62, p = 0.01), and lower class I plasma reactive antigens (2.64 vs 3.69%, p = 0.001). HSDs were older (40.9 vs 32.6 years, p < 0.001) and less likely male (51.7 vs 59.7%, p < 0.001). Recipients of lungs from HSDs had longer median length of stay (18.0 vs 17.0 days, p < 0.001). Freedom from bronchiolitis obliterans syndrome (p = 0.09), decrement in FEV1 (p = 0.12), peak FEV1 (79.8% vs 79.0%, p = 0.51), and median survival (2,043 vs 1,928 days, p = 0.69) were not different. On multivariate analysis, HSD lungs were not associated with death (hazard ratio, 1.003; 95% confidence interval, 0.867 to 1.161, p = 0.96). Death was associated with donor age, ischemic time, race mismatch, mechanical ventilation, and extracorporeal membranous oxygenation before transplantation.
  
  
  CONCLUSIONS
  Double-lung transplantation can be safely performed with lungs from donors with a heavy smoking history.
authors.affiliation: Department of Surgery, Temple University School of Medicine, Philadelphia, Pennsylvania, USA.
authors.forename: Sharven
authors.initials: S
authors.lastname: Taghavi
authors.forename: Senthil
authors.initials: S
authors.lastname: Jayarajan
authors.forename: Eugene
authors.initials: E
authors.lastname: Komaroff
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Horai
authors.forename: Stacey
authors.initials: S
authors.lastname: Brann
authors.forename: Francis
authors.initials: F
authors.lastname: Cordova
authors.forename: Gerard
authors.initials: G
authors.lastname: Criner
authors.forename: T Sloane
authors.initials: TS
authors.lastname: Guy
authors.forename: Yoshiya
authors.initials: Y
authors.lastname: Toyoda
mesh_terms: D000328:Adult; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D016040:Lung Transplantation / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D016016:Proportional Hazards Models; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology*; D015996:Survival Rate; D014019:Tissue Donors; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome