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. 2020 May;33(5):544-554.
doi: 10.1111/tri.13582. Epub 2020 Feb 13.

Impact of donor lung quality on post-transplant recipient outcome in the Lung Allocation Score era in Eurotransplant - a historical prospective study

Jacqueline M Smits  1 , Jens Gottlieb  2   3 , Erik Verschuuren  4 , Patrick Evrard  5 , Rogier Hoek  6 , Christiane Knoop  7 , György Lang  8 , Johanna M Kwakkel-van Erp  9 , Robin Vos  10 , Geert Verleden  10 , Benoit Rondelet  11 , Daniel Hoefer  12 , Frank Langer  13 , Rene Schramm  14 , Konrad Hoetzenecker  8 , Diana van Kessel  15 , Bart Luijk  16 , Leonard Seghers  6 , Tobias Deuse  17 , Roland Buhl  18 , Christian Witt  19 , Agita Strelniece  1 , Dave Green  1 , Erwin de Vries  1 , Guenter Laufer  20 , Dirk Van Raemdonck  21
Affiliations

Impact of donor lung quality on post-transplant recipient outcome in the Lung Allocation Score era in Eurotransplant - a historical prospective study

Jacqueline M Smits et al. Transpl Int. 2020 May.

Abstract

The aim of this study was to investigate whether there is an impact of donation rates on the quality of lungs used for transplantation and whether donor lung quality affects post-transplant outcome in the current Lung Allocation Score era. All consecutive adult LTx performed in Eurotransplant (ET) between January 2012 and December 2016 were included (N = 3053). Donors used for LTx in countries with high donation rate were younger (42% vs. 33% ≤45 years, P < 0.0001), were less often smokers (35% vs. 46%, P < 0.0001), had more often clear chest X-rays (82% vs. 72%, P < 0.0001), had better donor oxygenation ratios (20% vs. 26% with PaO2 /FiO2 ≤ 300 mmHg, P < 0.0001), and had better lung donor score values (LDS; 28% vs. 17% with LDS = 6, P < 0.0001) compared with donors used for LTx in countries with low donation rate. Survival rates for the groups LDS = 6 and ≥7 at 5 years were 69.7% and 60.9% (P = 0.007). Lung donor quality significantly impacts on long-term patient survival. Countries with a low donation rate are more oriented to using donor lungs with a lesser quality compared to countries with a high donation rate. Instead of further stretching donor eligibility criteria, the full potential of the donor pool should be realized.

Keywords: donation; donor; expanded donor pool; lung clinical; outcome.

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Conflict of interest statement

The authors have no conflict of interest to disclose.

Figures

Figure 1
Figure 1
Donation rates per million population of used diseased donor lungs, by year, by donor country.
Figure 2
Figure 2
Proportion of lung‐only transplants by lung donor score over time.
Figure 3
Figure 3
Proportion of lung‐only transplants by donor age over time.
Figure 4
Figure 4
(a) Proportion of lung‐only transplants by donor X‐ray classes over time. (b) Proportion of lung‐only transplants by donor bronchoscopy classes over time. (c) Proportion of lung‐only transplants by donor PaO2/FiO2 classes over time. (d) Proportion of lung‐only transplants by donor smoking status over time.
Figure 5
Figure 5
Post‐transplant survival by lung donor score [LDS = 6 (N = 638) dark blue line and LDS ≥7 (N = 2415) light green line].
See this image and copyright information in PMC

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