Frontiers in medicine · 2026
Lung transplantation from polytrauma donors: beyond primary graft dysfunction.
СтатьяНазвание и аннотация: Перевод в очереди
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Catelli Chiara, Marianello Daniele, Lloret Madrid Andrea, Rizzo Marianna, D'Alessandro Miriana, Sambo Margherita, Montagnani Francesca, Guerrieri Marco, Bennett David, Bargagli Elena, Paladini Piero, Franchi Federico, Luzzi Luca
Аннотация
BACKGROUND: Lung donors are increasingly older and marginal. Polytrauma donors (PD) represent a potentially valuable resource due to their younger age, although trauma-related lung injury raises concerns regarding graft quality. This study aimed to evaluate early and mid-term outcomes after lung transplantation using lungs from PDs compared with non-polytrauma donors (NPD).
METHODS: We retrospectively analyzed 125 lung transplant recipients from brain-dead donors between January 2013 and June 2024. Perioperative outcomes, primary graft dysfunction (PGD), and pulmonary function at 1, 3, and 6 months were compared between PD (n = 36) and NPD (n = 89) groups. To account for baseline differences, a 1:1 propensity score matching (PSM) was performed based on donor age, recipient age, and ischemic time.
RESULTS: In the overall cohort, PDs were younger and more frequently male, with a higher prevalence of pulmonary contusions. Early postoperative outcomes, including PGD, ICU stay, and perioperative complications, were comparable between groups. At 6 months, overall survival was higher in the PD group (91.7 vs. 75.3%, p = 0.048). After PSM, no significant differences were observed in survival (p = 0.66), perioperative outcomes, or pulmonary function. Functional recovery and CLAD rates were similar between groups across all time points.
CONCLUSIONS: Lung transplantation using grafts from polytrauma donors is not associated with worse perioperative or mid-term outcomes. After adjustment for baseline differences, outcomes were comparable to those from non-polytrauma donors, supporting the safe and selective use of these grafts as a strategy to expand the donor pool.
METHODS: We retrospectively analyzed 125 lung transplant recipients from brain-dead donors between January 2013 and June 2024. Perioperative outcomes, primary graft dysfunction (PGD), and pulmonary function at 1, 3, and 6 months were compared between PD (n = 36) and NPD (n = 89) groups. To account for baseline differences, a 1:1 propensity score matching (PSM) was performed based on donor age, recipient age, and ischemic time.
RESULTS: In the overall cohort, PDs were younger and more frequently male, with a higher prevalence of pulmonary contusions. Early postoperative outcomes, including PGD, ICU stay, and perioperative complications, were comparable between groups. At 6 months, overall survival was higher in the PD group (91.7 vs. 75.3%, p = 0.048). After PSM, no significant differences were observed in survival (p = 0.66), perioperative outcomes, or pulmonary function. Functional recovery and CLAD rates were similar between groups across all time points.
CONCLUSIONS: Lung transplantation using grafts from polytrauma donors is not associated with worse perioperative or mid-term outcomes. After adjustment for baseline differences, outcomes were comparable to those from non-polytrauma donors, supporting the safe and selective use of these grafts as a strategy to expand the donor pool.