Lung transplantation from donors outside standard acceptability criteria - are they really marginal?

Abstract

SummaryLung transplantation (LTx) from "extended donor criteria" donors may reduce significantly organ shortage. However, its influence on results remains unclear. In this study, we evaluate retrospectively the results of LTx from donors outside standard criteria: PaO2/FiO2 ratio < 300 mmHg, age over 55 years, and history of smoking > 20 pack-years. Two hundred and forty-eight patients underwent first time LTx in our institution between January 2007 and January 2013. Seventy-nine patients (Group I) received organs from "extended donor criteria" and 169 patients (Group II) from "standard donor criteria." Recipients' and donors' demographics, perioperative variables, and outcome were compared. Donors from Group I were significantly older [median (interquartile range)]: 52.5 (44;58) vs. 42 (28.5;48.5) years (P < 0.001) with lower PaO2/FiO2 ratio: 366 AE 116.1 455 AE 80.5 mmHg (P < 0.001), higher incidence of smoking history: 57.7% vs. 41.8% (P = 0.013), and more extensive smoking history: 24(15;30) vs. 10 (3.75;14) pack-years (P < 0.001). Other parameters were comparable. Recipients' gender, diagnosis, percentage of patients operated on pump and receiving double LTx were also comparable. Recipients from Group I were significantly older: 50 (42;57) vs. 44 (29.5;53.5) years (P = 001). There were no differences observed in recipients' prevalence of primary graft dysfunction (PGD) grade 3 over first three postoperative days, duration of mechanical ventilation, intensive care and hospital length of stay, prevalence of rejection, and bronchiolitis obliterans syndrome (BOS). 90-day, 1-year, and 5-year survival (Group I vs. II) were also similar: 88.6% vs. 91.7%, 83.2% vs. 84.6%, and 59% vs. 68.2% (log rank P = 0.367). Carefully selected donor lungs from outside the standard acceptability criteria may expand existing donor pool with no detrimental effect on LTx outcome.

Hanging donor lungs give good short‐, mid‐ and long‐term results in lung transplantation

“…However, results from these marginal donor lungs for conventional transplantation have been mixed. A number of studies have reported good short‐ and medium‐term results using non‐optimal lung donors …”

“…The shortage of lung donors is one of the main obstacles when aiming for a perfect match . The use of marginal donors is one of the strategies for increasing the lung graft pool . However, the average wait time is still too long, resulting in a considerable number of deaths on the waiting list .…”

Giving new life to old lungs: methods to produce and assess whole human paediatric bioengineered lungs

“…The age of donors may be important for scaffold production and donor cell isolation. Studies have indicated that lungs from donors > 55 years may be used for transplant, with an acceptable outcome (Zych et al, ). Our lung donors were all aged < 55 years but further work needs to be done to examine the influence of human donor age on AC scaffold production, as well as cell and bioengineered tissue viability.…”

Survival and spirometry outcomes after lung transplantation from donors aged 70 years and older

“…5 Above that, lungs from donors with conditions like lung contusion 6 or pulmonary embolism 7 have been successfully transplanted. 3,[8][9][10] The worldwide increase of transplantation of these extended criteria donor (ECD) lungs has had an important effect on transplant numbers, and a further increase seems possible with the widespread clinical application of ex vivo lung perfusion techniques for evaluation and/or reconditioning of ECD lungs. [11][12][13] With respect to donor age, a maximum of 55 years was set in 1999 by Novick et al 14 Although this age has been gradually increased in the meantime, still the largest remaining underutilized donor segment is the elderly.…”