title: A decade of extended-criteria lung donors in a single center: was it justified?
abstract: Despite a worldwide need to expand the lung donor pool, approximately 75% of lung offers are not accepted for transplantation. We investigated the impact of liberalizing lung donor acceptance criteria during the last decade on the number of effective transplants and early and late outcomes in our center. All 514 consecutive lung transplants (LTx) performed between Jan 2000 and Oct 2011 were included. Donors were classified as matching standard criteria (SCD; n = 159) or extended criteria (ECD; n = 272) in case they fulfilled at least one of the following criteria: age >55 years, PaO2 /FiO2 at PEEP 5 cmH2 O < 300 mmHg at time of offer, presence of abnormalities on chest X-ray, smoking history, presence of aspiration, presence of chest trauma, or donation after circulatory death. Outcome parameters were primary graft dysfunction (PGD) grade at 0, 12, 24, and 48 h after LTx, time to extubation, stay in intensive care unit (ICU), early and late infection, acute rejection and bronchiolitis obliterans syndrome (BOS), and survival. Two hundred and seventy-two recipients (63.1%) received ECD lungs. PGD grade at T0 was similar between groups, while at T12 (<0.01), T24 (<0.01), and T48 (<0.05), PGD3 was observed more often in ECDs. ICU stay (P < 0.05) was longer in ECDs compared with SCDs. Time to extubation, respiratory infections, acute rejection, lymphocytic bronchiolitis, BOS, and survival were not different between groups. Accepting ECDs contributed in increasing the number of lung transplants performed in our center. Although this lung donor strategy has an impact on early postoperative outcome, liberalizing criteria did not influence long-term outcome after LTx.
authors.affiliation: Laboratory of Experimental Thoracic Surgery, Department of Clinical and Experimental Medicine, KU Leuven, University Hospital Gasthuisberg Leuven, Leuven, Belgium.
authors.forename: Jana
authors.initials: J
authors.lastname: Somers
authors.forename: David
authors.initials: D
authors.lastname: Ruttens
authors.forename: Stijn E
authors.initials: SE
authors.lastname: Verleden
authors.forename: Bianca
authors.initials: B
authors.lastname: Cox
authors.forename: Alessia
authors.initials: A
authors.lastname: Stanzi
authors.forename: Elly
authors.initials: E
authors.lastname: Vandermeulen
authors.forename: Robin
authors.initials: R
authors.lastname: Vos
authors.forename: Bart M
authors.initials: BM
authors.lastname: Vanaudenaerde
authors.forename: Geert M
authors.initials: GM
authors.lastname: Verleden
authors.forename: Hans
authors.initials: H
authors.lastname: Van Veer
authors.forename: Willy
authors.initials: W
authors.lastname: Coosemans
authors.forename: Herbert
authors.initials: H
authors.lastname: Decaluwe
authors.forename: Philippe
authors.initials: P
authors.lastname: Nafteux
authors.forename: Paul
authors.initials: P
authors.lastname: De Leyn
authors.forename: Dirk E
authors.initials: DE
authors.lastname: Van Raemdonck
mesh_terms: D000328:Adult; D003643:Death; D005260:Female; D006801:Humans; D007902:Length of Stay; D016040:Lung Transplantation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014019:Tissue Donors
keywords: early post-transplant outcome; extended-criteria donor; late post-transplant outcome; lung donors; lung transplantation; thoracic surgery