Short- and long-term outcomes of using pulmonary allograft donors with low Po2.

BACKGROUND

The establishment of lung transplantation as a treatment modality for end-stage lung disease has led to an imbalance in the demand and supply for such a procedure. Increasingly marginal donors are being accepted for transplantation. We assessed the short- and long-term outcomes with the use of lung donors with low Po(2).

METHODS

All heart-lung and double lung transplantations (n = 362) carried out between 1984 and 2001 were included. Recipients were divided according to the optimized donor Po(2) (on 100% Fio(2)): Po(2) = 30 to 40 kPa = low Po(2) donors (n = 50) and Po(2) >40 kPa = normal Po(2) donors (n = 312). There were no differences in the sex distribution, cytomegalovirus infection status, ischemic time, and intubation durations for the recipients and their respective donors between the 2 groups. The low Po(2) donors were older (38 vs 32 years, p = 0.01) and the allografts were transplanted into younger recipients (33 vs 38 years, p = 0.01).

RESULTS

There was a trend toward an increase in the 30-day mortality between the 2 groups (22% vs 13%, odds ratio 1.92, 95% confidence interval 0.91-4.05 p = 0.08). The 1- and 5-year survival rates (standard error) were 66% (7%) and 52% (7%) for the low Po(2) group and 72% (3%) and 44% (3%) for the normal Po(2) group (p = 0.97). Similar infection rates were recorded for the groups. Although rejection rates were similar in the first 3 months, there was a lower rate of rejection in the low Po(2) group thereafter, (hazard ratio, 0.52; p = 0.05). Risk of bronchiolitis obliterans syndrome (BOS) onset was marginally increased in the borderline donors (hazard ratio 1.05, 95% confidence interval 0.68-1.62), although this was not statistically significant.

CONCLUSIONS

Donor lung allograft, with optimized Po(2) between 30 and 40 kPa on 100% Fio(2), used for lung transplantation did compromise 30-day mortality, but the difference in mortality did not extend beyond 30 days in our patient group.