title: Lung transplantation from donors outside standard acceptability criteria--are they really marginal?
abstract: Lung transplantation (LTx) from "extended donor criteria" donors may reduce significantly organ shortage. However, its influence on results remains unclear. In this study, we evaluate retrospectively the results of LTx from donors outside standard criteria: PaO2/FiO2 ratio < 300 mmHg, age over 55 years, and history of smoking > 20 pack-years. Two hundred and forty-eight patients underwent first time LTx in our institution between January 2007 and January 2013. Seventy-nine patients (Group I) received organs from "extended donor criteria" and 169 patients (Group II) from "standard donor criteria." Recipients' and donors' demographics, perioperative variables, and outcome were compared. Donors from Group I were significantly older [median (interquartile range)]: 52.5 (44;58) vs. 42 (28.5;48.5) years (P < 0.001) with lower PaO2/FiO2 ratio: 366 ± 116.1 455 ± 80.5 mmHg (P < 0.001), higher incidence of smoking history: 57.7% vs. 41.8% (P = 0.013), and more extensive smoking history: 24(15;30) vs. 10(3.75;14) pack-years (P < 0.001). Other parameters were comparable. Recipients' gender, diagnosis, percentage of patients operated on pump and receiving double LTx were also comparable. Recipients from Group I were significantly older: 50 (42;57) vs. 44 (29.5;53.5) years (P = 001). There were no differences observed in recipients' prevalence of primary graft dysfunction (PGD) grade 3 over first three postoperative days, duration of mechanical ventilation, intensive care and hospital length of stay, prevalence of rejection, and bronchiolitis obliterans syndrome (BOS). 90-day, 1-year, and 5-year survival (Group I vs. II) were also similar: 88.6% vs. 91.7%, 83.2% vs. 84.6%, and 59% vs. 68.2% (log rank P = 0.367). Carefully selected donor lungs from outside the standard acceptability criteria may expand existing donor pool with no detrimental effect on LTx outcome.
authors: Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Harefield, UK.
authors: Bartlomiej
authors: B
authors: Zych
authors: Diana
authors: D
authors: García Sáez
authors: Anton
authors: A
authors: Sabashnikov
authors: Fabio
authors: F
authors: De Robertis
authors: Mohamed
authors: M
authors: Amrani
authors: Toufan
authors: T
authors: Bahrami
authors: Prashant N
authors: PN
authors: Mohite
authors: Nikhil P
authors: NP
authors: Patil
authors: Alexander
authors: A
authors: Weymann
authors: Aron F
authors: AF
authors: Popov
authors: Anna
authors: A
authors: Reed
authors: Martin
authors: M
authors: Carby
authors: André R
authors: AR
authors: Simon
mesh_terms: D000328:Adult; D001926:Brain Death; D001989:Bronchiolitis Obliterans / Q000209:etiology; D003643:Death; D046148:Donor Selection / Q000379:methods* / Q000592:standards; D005260:Female; D006084:Graft Rejection / Q000209:etiology; D006801:Humans; D016040:Lung Transplantation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D055031:Primary Graft Dysfunction / Q000209:etiology; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000503:physiopathology / Q000601:surgery; D012189:Retrospective Studies; D013997:Time Factors; D014019:Tissue Donors; D020858:Tissue and Organ Harvesting / Q000379:methods; D016896:Treatment Outcome
keywords: extended donor criteria; lung transplantation; outcome