title: Donors with a prior history of cardiac surgery are a viable source of lung allografts.
abstract: OBJECTIVE
  End-stage lung disease continues to rise despite the lack of suitable lung donors, limiting the numbers of lung transplants performed each year. Expanded donor criteria, use of donation after cardiac death donors and the advent of ex vivo lung perfusion have resulted only in a slight increase in donor lung utilization. Organ donors with prior cardiac surgery (DPCS) present risks and technical challenges; however, they may be a potential source of suitable lung allografts with an experienced procurement surgeon. We present our experience having evaluated potential lung donors with a prior history of cardiac surgery, resulting in successful transplant outcomes.
  
  
  METHODS
  This is a single-institution retrospective review of brain-dead organ donors that were evaluated for lung donation in the period 2012-15. Donor and recipient characteristics were collected. Post-lung transplant survival was recorded.
  
  
  RESULTS
  From 2012 to 2015, 259 donors were evaluated, 12 with a prior history of cardiac surgery of which 4 had coronary artery bypass, 3 had aortic root replacement, 2 had aortic valve replacement, 1 pulmonary embolectomy, 1 two-time reoperative valve replacement and 1 paediatric congenital ventricular septal defect repair. DPCS, 6/12 (50% dry run) provided suitable allografts generating six single-lung transplants (three right and three left, 1 donor provided twin single-lung transplants) and one double-lung transplant. Interval between cardiac surgery and procurement for those rejected was median 5840 (IQR 2350-8640) days and interval for the donors that provided allografts was median 438 (IQR 336-1095) days (Mann-Whitney, P = 0.07). Recipient 1-year survival from DPCS is 100%. Recipient 1-year survival was 92% in allografts explanted from donors with no prior cardiac surgery (2012-13).
  
  
  CONCLUSIONS
  To date, this is the largest single-centre experience using lung allografts from brain-dead DPCS. Our experience shows despite predicted technical difficulties, with good communication between thoracic and abdominal teams, successful transplant outcomes are possible, when surgeons with experience in reoperative cases are sent for lung procurements.
authors.affiliation: Department of Surgery, Division of Cardiac, Vascular and Thoracic Surgery, Columbia University Medical Center, New York, NY, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Costa
authors.affiliation: Department of Surgery, Division of Cardiac, Vascular and Thoracic Surgery, Columbia University Medical Center, New York, NY, USA.
authors.forename: Sowmyashree
authors.initials: S
authors.lastname: Sreekanth
authors.affiliation: Department of Surgery, Division of Cardiac, Vascular and Thoracic Surgery, Columbia University Medical Center, New York, NY, USA.
authors.forename: Alex
authors.initials: A
authors.lastname: Kossar
authors.affiliation: Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Medical Center, New York, NY, USA.
authors.forename: Kashif
authors.initials: K
authors.lastname: Raza
authors.affiliation: Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Medical Center, New York, NY, USA.
authors.forename: Hilary
authors.initials: H
authors.lastname: Robbins
authors.affiliation: Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Medical Center, New York, NY, USA.
authors.forename: Lori
authors.initials: L
authors.lastname: Shah
authors.affiliation: Department of Surgery, Division of Cardiac, Vascular and Thoracic Surgery, Columbia University Medical Center, New York, NY, USA.
authors.forename: Joshua R
authors.initials: JR
authors.lastname: Sonett
authors.affiliation: Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Medical Center, New York, NY, USA.
authors.forename: Selim
authors.initials: S
authors.lastname: Arcasoy
authors.affiliation: Department of Surgery, Division of Cardiac, Vascular and Thoracic Surgery, Columbia University Medical Center, New York, NY, USA fd2133@cumc.columbia.edu.
authors.forename: Frank
authors.initials: F
authors.lastname: D'Ovidio
mesh_terms: D000328:Adult; D001926:Brain Death; D006348:Cardiac Surgical Procedures; D002423:Cause of Death; D005260:Female; D006801:Humans; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000379:methods*
keywords: Central gases; Donor lung assessment; Prior cardiac surgery; Pulmonary graft dysfunction; Reoperative donors; Selective pulmonary vein gases