title: Extended recipients but not extended donors are associated with poor outcomes following lung transplantation.
abstract: OBJECTIVE
  Extended donors (EDs) are safely used to increase the donor pool in lung transplantation (LT), but their influence in critically ill patients (extended recipients [ERs]) remains controversial. We compared LT outcomes matching optimal donors (ODs) or EDs with optimal recipients (ORs) or ERs.
  
  
  METHODS
  Three hundred and sixty-five LTs were reviewed. ED criteria: age >55, PaO2/FiO2 < 350 mmHg, pulmonary infiltrates/purulent secretions and ischaemic times >6 h (single LT [SLT]) and >9 h (double LT [DLT]). ER criteria: pulmonary fibrosis or pulmonary hypertension, pretransplant intubation, age >60 years and bypass >2 h. Four groups were created: Group 1 (OD/OR), Group 2 (OD/ER), Group 3 (ED/OR) and Group 4 (ED/ER). Thirty-day mortality, primary graft dysfunction (PGD), onset of bronchiolitis obliterans syndrome (BOS), long-term survival and other transplant outcomes were compared between OD and ED, OR and ER and among the four groups of study.
  
  
  RESULTS
  There were 151 SLTs and 214 DLTs. Donors: OD (n = 229) vs ED (n = 136); PGD 8 vs 10% (P = 0.43); 30-day mortality 19 vs 20% (P = 0.53) and survival (1, 5, 10 and 15 years) 67, 47, 34, 26 vs 69, 53, 46 and 29% (P = 0.33). Recipients: OR (n = 182) vs ER (n = 183); PGD 7 vs 10% (P = 0.10); 30-day mortality 15 vs 23% (P = 0.04) and survival (1, 5, 10 and 15 years): 73, 57, 46, 30 vs 61, 42, 29 and 23% (P = 0.002). Four donor/recipient (D/R) groups: Group 1 (n = 122), Group 2 (n = 106), Group 3 (n = 61), Group 4 (n = 76); PGD 10, 6, 3 and 16% (P = 0.05); 30-day mortality 13, 26, 19 and 20%, respectively (P = 0.13); survival (1, 5, 10 and 15 years) 74, 55, 44 and 35% (Group 1), 55, 39, 22 and 16% (Group 2), 70, 59, 48 and 26% (Group 3) and 68, 47, 37 and 22% (Group 4) (P = 0.004). No differences in the onset of BOS were observed among the four study groups.
  
  
  CONCLUSIONS
  LT in critically ill recipients is associated with poor early and long-term outcomes, irrespective of the quality of the donor and length of ischaemic times.
authors.affiliation: Thoracic Surgery and Lung Transplantation Unit, University Hospital Reina Sofia, Cordoba, Spain Group for the Study of Thoracic Neoplasms and Lung Transplantation, IMIBIC (Instituto Maimónides de Investigación Biomédica de Córdoba), University of Córdoba, Córdoba, Spain pmoreno39@gmail.com.
authors.forename: Paula
authors.initials: P
authors.lastname: Moreno
authors.affiliation: Thoracic Surgery and Lung Transplantation Unit, University Hospital Reina Sofia, Cordoba, Spain Group for the Study of Thoracic Neoplasms and Lung Transplantation, IMIBIC (Instituto Maimónides de Investigación Biomédica de Córdoba), University of Córdoba, Córdoba, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Alvarez
authors.affiliation: Thoracic Surgery and Lung Transplantation Unit, University Hospital Reina Sofia, Cordoba, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Santos
authors.affiliation: Thoracic Surgery and Lung Transplantation Unit, University Hospital Reina Sofia, Cordoba, Spain.
authors.forename: José Manuel
authors.initials: JM
authors.lastname: Vaquero
authors.affiliation: Thoracic Surgery and Lung Transplantation Unit, University Hospital Reina Sofia, Cordoba, Spain Group for the Study of Thoracic Neoplasms and Lung Transplantation, IMIBIC (Instituto Maimónides de Investigación Biomédica de Córdoba), University of Córdoba, Córdoba, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Baamonde
authors.affiliation: Thoracic Surgery and Lung Transplantation Unit, University Hospital Reina Sofia, Cordoba, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Redel
authors.affiliation: Thoracic Surgery and Lung Transplantation Unit, University Hospital Reina Sofia, Cordoba, Spain Group for the Study of Thoracic Neoplasms and Lung Transplantation, IMIBIC (Instituto Maimónides de Investigación Biomédica de Córdoba), University of Córdoba, Córdoba, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Cerezo
authors.affiliation: Thoracic Surgery and Lung Transplantation Unit, University Hospital Reina Sofia, Cordoba, Spain Group for the Study of Thoracic Neoplasms and Lung Transplantation, IMIBIC (Instituto Maimónides de Investigación Biomédica de Córdoba), University of Córdoba, Córdoba, Spain.
authors.forename: Francisco Javier
authors.initials: FJ
authors.lastname: Algar
authors.affiliation: Thoracic Surgery and Lung Transplantation Unit, University Hospital Reina Sofia, Cordoba, Spain Group for the Study of Thoracic Neoplasms and Lung Transplantation, IMIBIC (Instituto Maimónides de Investigación Biomédica de Córdoba), University of Córdoba, Córdoba, Spain.
authors.forename: Angel
authors.initials: A
authors.lastname: Salvatierra
mesh_terms: D000293:Adolescent; D000328:Adult; D001989:Bronchiolitis Obliterans / Q000453:epidemiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D016040:Lung Transplantation / Q000009:adverse effects* / Q000379:methods / Q000401:mortality*; D008875:Middle Aged; D012189:Retrospective Studies; D014019:Tissue Donors / Q000706:statistics & numerical data*; D066027:Transplant Recipients / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Extended donors; Extended recipients; Lung donor criteria; Lung donor pool; Lung transplantation; Marginal donor lungs