title: The use of extended criteria donors decreases one-year survival in high-risk lung recipients: A review of the United Network of Organ Sharing Database.
abstract: The study objective was to investigate the impact of matching donor quality to recipient severity on survival after lung transplant.
  
  
  
  By using the Organ Procurement and Transplantation Network/United Network for Organ Sharing dataset, we analyzed lung transplant recipients from May 4, 2005, to December 31, 2012. By using adjusted Cox regressions, we identified extended criteria donors as those who had 1 or more of the following: age 65 years or more, smoking history of 20 pack-years or more, diabetes mellitus, or African-American race. All other donors were considered standard donors. Recipients were categorized by lung allocation score: lung allocation score less than 70 and lung allocation score 70 or greater. Our primary outcome was 1-year survival after lung transplantation.
  
  
  
  Of the 10,995 lung recipients, 3792 (34%) received extended criteria donor organs. Extended criteria donors were associated with an increased hazard of death (hazard ratio [HR], 1.41; 95% confidence interval [CI], 1.26-1.56; P < .001). One-year survival was 87% and 82% (P < .001) for recipients with a lung allocation score less than 70 and 80% and 72% (P = .017) for recipients with a lung allocation score 70 or greater who received standard donor and extended criteria donor organs, respectively. In Cox regression models, the hazard of death was increased for recipients with a lung allocation score less than 70 + extended criteria donor (HR, 1.42; 95% CI, 1.27-1.60; P < .001), recipients with a lung allocation score 70 or greater + standard donor (HR, 1.37; 95% CI, 1.10-1.71; P = .005), and was the highest for recipients with a lung allocation score 70 or greater + extended criteria donor (HR, 1.81; 95% CI, 1.40-2.33; P < .001) compared with recipients with a lung allocation score less than 70 + standard donor.
  
  
  
  Extended criteria donors are associated with reduced 1-year survival, and recipients with a lung allocation score 70 or greater who receive extended criteria donor organs have the lowest survival.
authors.affiliation: University of Maryland School of Medicine, Baltimore, Md.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Mulligan
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Md.
authors.forename: Pablo G
authors.initials: PG
authors.lastname: Sanchez
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Md.
authors.forename: Charles F
authors.initials: CF
authors.lastname: Evans
authors.affiliation: Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Md.
authors.forename: Yan
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Md.
authors.forename: Zachary N
authors.initials: ZN
authors.lastname: Kon
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Md.
authors.forename: Keshava
authors.initials: K
authors.lastname: Rajagopal
authors.affiliation: R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Md.
authors.forename: Aldo T
authors.initials: AT
authors.lastname: Iacono
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Md.
authors.forename: James S
authors.initials: JS
authors.lastname: Gammie
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Md.
authors.forename: Bartley P
authors.initials: BP
authors.lastname: Griffith
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Md. Electronic address: spham@smail.umaryland.edu.
authors.forename: Si M
authors.initials: SM
authors.lastname: Pham
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American; D000367:Age Factors; D000368:Aged; D003920:Diabetes Mellitus; D005260:Female; D006801:Humans; D016040:Lung Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012907:Smoking; D015996:Survival Rate; D014019:Tissue Donors / Q000145:classification*
keywords: extended lung donor; lung transplantation