title: Does Traumatic Donor Cause of Death Influence Outcome after Lung Transplantation? A Single-Centre Analysis.
abstract: BackgroundOwing to the shortage of donor organs in lung transplantation (LuTX), liberalization of donor selection criteria has been proposed. However, some studies suggested that donor traumatic brain damage might influence posttransplantation allograft function. This article aimed to investigate the association of donor cause of death (DCD) and outcome after LuTX.MethodsA retrospective analysis of 186 consecutive double LuTXs at our institution from January 2000 to December 2008 was performed. DCD was categorized into traumatic brain injury (TBI) and nontraumatic brain injury (NTBI). In addition, NTBI was sub classified as spontaneous intracerebral bleeding (B), hypoxic brain damage (H), and intracerebral neoplasia (N).ResultsDCD was classified as TBI in 50 patients (26.9%) and NTBI in 136 patients (73.1%): B in 112 patients (60.2%), H in 21 patients (11.3%), and N in 3 patients (1.6%). Young male donors predominated in group TBI (mean age 36.0 ± 14.5 vs. 42.8 ± 10.7,p< 0.01; 29 males in the TBI group [58.0%] vs. 48 males in the NTBI group [35.3%],p< 0.01). Groups of DCD did not differ significantly by recipient age or gender, recipient diagnosis, donor ventilation time, or paO2/FiO2before harvesting. TBI donors received significantly more blood (3.4 ± 3.8 vs. 1.8 ± 1.9,p= 0.03). A chest trauma was evident only in group T (n= 7 [3.7%] vs. 0 [0%],p< 0.001). Mode of donor death did not affect the following indices of graft function: length of postoperative ventilation, paO2/FiO2ratio up to 48 hours, and lung function up to 36 months. One- and three-year survival was comparable with 84.4 and 70.4% for TBI donors versus 89.4% and 69.2% for NTBI donors. Five-year survival tended to be lower in the TBI group but did not reach statistical significance (43.4 vs. 53.9%).ConclusionThis study indicates thattraumaticDCD does not affect outcome after LuTX. These results can be achieved with an ideal donor management combined with an individual case-to-case evaluation by an experienced LuTX surgeon.
authors.affiliation: Department of Intensive Care Medicine, Imland Klinik Rendsburg, Rendsburg, Germany.
authors.forename: Kevin
authors.initials: K
authors.lastname: Pilarczyk
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Heckmann
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany.
authors.forename: Henning
authors.initials: H
authors.lastname: Carstens
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany.
authors.forename: Jura
authors.initials: J
authors.lastname: Lubarski
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany.
authors.forename: Heinz
authors.initials: H
authors.lastname: Jakob
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany.
authors.forename: Nikolaus
authors.initials: N
authors.lastname: Pizanis
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Kamler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000070642:Brain Injuries, Traumatic / Q000401:mortality*; D001932:Brain Neoplasms / Q000401:mortality; D002423:Cause of Death; D002543:Cerebral Hemorrhage / Q000401:mortality; D046148:Donor Selection; D005260:Female; D005858:Germany; D006801:Humans; D002534:Hypoxia, Brain / Q000401:mortality; D053208:Kaplan-Meier Estimate; D016040:Lung Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014019:Tissue Donors / Q000600:supply & distribution*; D016896:Treatment Outcome; D055815:Young Adult