The number of lung transplants can be safely doubled using extended criteria donors; A single-center review

Abstract

Summary Relaxing the standard lung donor criteria may significantly increase the reported 15% organ yield but post‐transplant recipient outcome should be carefully monitored. Charts from all consecutive deceased organ donors within our hospital network were reviewed over a 2‐year period. Reasons for lung refusals and number of lungs transplanted were analysed. Hospital outcome including early recipient survival was compared between standard‐ and extended criteria donors. Out of 283 referrals, 164 (58%) qualified as donor of any organ. The majority (65.9%) of these effective donors were declined for lung donation because of chest X‐ray abnormalities (20%), age >70 years (13%), poor oxygenation (10%), or aspiration (9%). Out of 56 (34.1%) accepted lung donors, 50 transplants were performed at our center, 23 from standard criteria donors versus 27 from extended criteria donors. There were no significant differences in hospital outcome and in early survival between lung recipients from both donor groups. Lung acceptance rate (34.1%) in our donor network is 10–20% higher than reported figures. The number of lung transplants in our center doubled by accepting extended criteria donors. This policy did not negatively influence our results after lung transplantation.

Clinical Ex Vivo Lung Perfusion—Pushing the Limits

“…Various strategies including active donor management and extension of donor criteria have been applied to alleviate this problem (5,13). However, it has also been shown that the initial function of the transplanted lung significantly influences perioperative and long-term outcome and that marginal donor organs may compromise recipient outcome, especially when used for high-risk recipients (14,15).…”

A Porcine Model of Acute Lung Injury by Instillation of Gastric Fluid

“…We recently observed an increase in donor lung acceptance rate from 7% to 34% as a result of relaxing our lung donor criteria since 2000 [3]. Aspiration of gastric juice was a reason to decline donor lungs in 14% of the rejected lungs [4].…”

State of Art: Clinical ex vivo lung perfusion: Rationale, current status, and future directions

“…A recent analysis found lungs classified as "marginal" based on an array of different criteria failed to identify any detrimental effect on clinical outcomes. 2 The use of marginal lungs raises many difficult scientific, logistical, and ethical questions:• What readily available, practical metrics, or innovative interventions can be applied to more accurately differentiate between "viable" grafts-lungs likely to perform as well as conventional criteria grafts-from those likely to fail?• Which lungs can be better assessed by ex vivo perfusion after donation, and perhaps repaired by logical but as yet unproven interventions?Ex vivo lung perfusion (EVLP) has been suggested as a novel method to differentiate between "good" and "bad" grafts in this sub-optimal population, because when these good grafts are transplanted, results are not different from standard criteria lungs. 3,4 But as the use of ex vivo evaluated lungs increases, new questions are emerging.…”

“…A recent analysis found lungs classified as "marginal" based on an array of different criteria failed to identify any detrimental effect on clinical outcomes. 2 The use of marginal lungs raises many difficult scientific, logistical, and ethical questions:…”