Donor issue
Influence of Donor Characteristics on Outcome After Lung Transplantation: A Multicenter Study

https://doi.org/10.1016/j.healun.2004.10.016Get rights and content

Background

The liberalization of lung-donor criteria and the use of marginal donors have been advocated to face the current shortage of donors in lung transplantation. However, the impact of donor characteristics on the outcome of lung transplantation is still largely unknown. We aimed to determine, on a large cohort of patients, the effect of donors characteristics on short- and long-term outcome of lung transplantation

Methods

Between 1988 and 1998, a total of 785 adult patients underwent single-lung transplantation (n = 270), bilateral-lung transplantation (n = 251), and heart-lung transplantation (n = 264) in 7 centers in France. We constructed several multivariate models to assess the relationship between donor characteristics and early gas exchange, duration of mechanical ventilation, and long-term survival after lung transplantation.

Results

Among donor characteristics, donor gas exchange before harvest was found to be significantly associated with recipient early gas exchange, duration of mechanical ventilation, and long-term survival after adjustment for potential confounding variables. Moreover, nonlinear modeling showed a steep increase in the relative risk of death when donor Pao2/Fio2 before harvest was below 350 (hazard ratio 1.43; 95% confidence interval 1.10–1.85; p = 0.01). Donor and recipient sex mismatch were also found to be significantly associated with long-term survival.

Conclusions

Although liberalization of lung-donor criteria may be considered to overcome the shortage of lung donors, our data suggest that the violation of the gas-exchange criterion should be avoided.

Section snippets

Material and methods

We used data collected as part of the study of the predictive factors of early mortality after LT designed by the French Lung Transplantation Group.14 The medical records of all adult patients who underwent single LT (SLT), bilateral LT (BLT), or heart LT (HLT) in 7 centers in France from January 1988 to December 1998 were retrospectively reviewed.

Results

During the study period (1988–1998), 785 patients underwent LT and met the selection criteria for the study. On the whole collected data, 4% were missing. Underlying diseases and surgical techniques differed markedly between centers. There were 270 SLT (178 right, 92 left), 251 BLT (82 en bloc, 169 sequential), and 264 HLT. Cardiopulmonary bypass was required in 494 cases (63.6%). In case of HLT or en bloc BLT, cardiopulmonary bypass was used in all cases; it was used in 93 cases (55.7%) of

Discussion

Since the first report in 1993 of a small series of lung transplantations performed with marginal donors,8 several small monocentric retrospective studies have focused on their use.9, 10, 11, 12, 13 All but one13 have yielded encouraging results in terms of early gas exchange, postoperative complications, pulmonary function, and mortality. On the basis of these articles, several authors advocate the liberalization of lung-donor selection criteria.

All the literature cited above used the same

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