title: Use of the donor lung after asphyxiation or drowning: effect on lung transplant recipients.
abstract: BACKGROUND
  With the relative paucity of acceptable donors for lung transplantation, criteria for extended donor consideration are being explored. We sought to evaluate the suitability of donors whose cause of death was asphyxiation or drowning (A/D) as a potential option to enlarge the donor pool.
  
  
  METHODS
  We queried the United Network for Organ Sharing (UNOS) Standard Transplant Analysis and Research registry for lung transplantation from 1987 to 2010 to assess associations between cause of death and recipient survival using the Kaplan-Meier method. To adjust for potential confounders, we used a Cox proportional hazards model and a logistic regression model to evaluate incidence of rejection within the first year.
  
  
  RESULTS
  There were 18,250 adult primary lung transplantations performed, with 309 A/D donors. There was no difference in survival between groups (log-rank, p = 0.52). There were no differences in demographics, length of stay, airway dehiscence, lung allocation score (LAS), or ischemic time in univariate analysis (all p > 0.05). The A/D lung recipients had fewer deaths from pulmonary causes (5.8% versus 9.5%; p = 0.02). Proportional hazards analysis was significant for double lung transplantation (hazard ratio [HR], 0.85; 95% confidence interval [CI], 0.8-0.9), height difference (HR, 1.002; 95% CI, 1.00-1.003), donor age greater than 50 years (HR, 0.89; 95% CI, 0.83-0.96), and recipient age greater than 55 years (HR, 0.8; 95% CI, 0.76-0.84). A/D cause of death did not impact survival in multivariate analysis.
  
  
  CONCLUSIONS
  A/D as a donor cause of death was not associated with poor long-term survival or incidence of rejection in the first year after transplantation. Donor cause of death by A/D, when carefully evaluated and selected, should not automatically exclude the organ from transplant consideration. These results provide important justification for potentially broadening the donor pool safely.
authors.affiliation: Department of Surgery, The University of Minnesota, Minneapolis, Minnesota; Department of Surgery, Division of Cardiac Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio. Electronic address: bryan.whitson@osumc.edu.
authors.forename: Bryan A
authors.initials: BA
authors.lastname: Whitson
authors.affiliation: Department of Medicine, The University of Minnesota, Minneapolis, Minnesota.
authors.forename: Marshall I
authors.initials: MI
authors.lastname: Hertz
authors.affiliation: Department of Surgery, The University of Minnesota, Minneapolis, Minnesota.
authors.forename: Rosemary F
authors.initials: RF
authors.lastname: Kelly
authors.affiliation: Department of Surgery, Division of Cardiac Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
authors.forename: Robert S D
authors.initials: RS
authors.lastname: Higgins
authors.affiliation: Department of Surgery, Division of Cardiac Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Kilic
authors.affiliation: Department of Surgery, The University of Minnesota, Minneapolis, Minnesota.
authors.forename: Sara J
authors.initials: SJ
authors.lastname: Shumway
authors.affiliation: Department of Surgery, The University of Minnesota, Minneapolis, Minnesota; Department of Cardiothoracic Surgery, The University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Jonathan
authors.initials: J
authors.lastname: D'Cunha
mesh_terms: D000328:Adult; D000368:Aged; D001237:Asphyxia / Q000503:physiopathology*; D004332:Drowning / Q000503:physiopathology*; D005260:Female; D006801:Humans; D016040:Lung Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D014019:Tissue Donors; D066027:Transplant Recipients