Extended Criteria Donors; a Safe Way To Expand the Lung Donor Pool?

PurposeAlthough the worldwide need to expand the lung donor pool, 75 % of multi-organ donors are discarded for lung transplantation (LTx). Herein, we report the outcome of liberalizing standard lung donor criteria.Methods and MaterialsAll effective heart-beating lung donors within our hospital network between 2000 and 2010 (n=449) were classified as standard (SCD, n=284) or extended (ECD, n=149) criteria donors according to age (>55years), P/F (<300mmHg) and the presence of chest x-ray abnormalities. With positive smoking status added as additional criterium, donors were reclassified as SCD (n=166) or ECD (n=212). Donor demographics were comparable between both groups. Time to extubation, ICU stay, pulmonary graft dysfunction (PGD) grades, acute and chronic rejection and survival in recipients were compared between groups.ResultsShort-term outcome demonstrated significant differences in ICU stay (p=0.03), PGD T12 (p=0.003), T24 (p=0.009) and T48 (p=0.03) but not for time to extubation (p=0.28). No significant differences were seen in long-term outcome like acute rejection (p=0.84), chronic rejection (p=0.18) and 10-year survival (p=0.33, Figure A). Adding donor smoking status resulted in similar findings. Significant differences remained in short-term outcome like PGD T12(p=0.001), T24(p=0.001) and T48(p=0.001), extubation time (p=0.04), ICU stay (p=0.02) was observed. While no differences were found for long-term outcome as acute rejection (P=0.85), chronic rejection (p=0.54) and survival (p=0.72, Figure B).ConclusionsAlthough, transplanting ECD lungs has an impact on the early post-operative outcome after LTx, even more pronounced for lungs from smokers, liberalization of lung donor criteria did not negatively influence long-term outcome after LTx. Although the worldwide need to expand the lung donor pool, 75 % of multi-organ donors are discarded for lung transplantation (LTx). Herein, we report the outcome of liberalizing standard lung donor criteria. All effective heart-beating lung donors within our hospital network between 2000 and 2010 (n=449) were classified as standard (SCD, n=284) or extended (ECD, n=149) criteria donors according to age (>55years), P/F (<300mmHg) and the presence of chest x-ray abnormalities. With positive smoking status added as additional criterium, donors were reclassified as SCD (n=166) or ECD (n=212). Donor demographics were comparable between both groups. Time to extubation, ICU stay, pulmonary graft dysfunction (PGD) grades, acute and chronic rejection and survival in recipients were compared between groups. Short-term outcome demonstrated significant differences in ICU stay (p=0.03), PGD T12 (p=0.003), T24 (p=0.009) and T48 (p=0.03) but not for time to extubation (p=0.28). No significant differences were seen in long-term outcome like acute rejection (p=0.84), chronic rejection (p=0.18) and 10-year survival (p=0.33, Figure A). Adding donor smoking status resulted in similar findings. Significant differences remained in short-term outcome like PGD T12(p=0.001), T24(p=0.001) and T48(p=0.001), extubation time (p=0.04), ICU stay (p=0.02) was observed. While no differences were found for long-term outcome as acute rejection (P=0.85), chronic rejection (p=0.54) and survival (p=0.72, Figure B). Although, transplanting ECD lungs has an impact on the early post-operative outcome after LTx, even more pronounced for lungs from smokers, liberalization of lung donor criteria did not negatively influence long-term outcome after LTx.