Impact of donor organ quality on recipient outcomes in lung transplantation: 14-Year single-center experience using the Eurotransplant lung donor score

Abstract

Background: The use of extended-criteria donor (ECD) organs has increased in lung transplantation, but their impact on long-term outcomes remains unclear. This retrospective single-center study evaluates the impact of donor quality, as defined by the Eurotransplant (ET) lung donor score, on long-term graft function and survival.

Methods: Records of recipients transplanted between January 2010 and May 2023 were reviewed. Eurotransplant lung donor scores (ET scores) were retrospectively calculated from the corresponding donor reports. Outcomes were compared between recipients of donor lungs with an ET score of 6 (group 1), 7 and 8 (group 2), and 9 to 13 (group 3, ECD lungs). Median follow-up was 64 (30-104) months.

Results: In total, 280 (19%) patients were transplanted with ET score 6 lungs, 717 (48%) patients with ET scores 7 and 8 lungs, and 506 (34%) patients with ET scores 9 to 13 (ECD) lungs. The occurrence of primary graft dysfunction grade 3 at 72 hours (p = 0.672), duration of mechanical ventilation (p = 0.062), and in-hospital mortality (p = 0.713) did not differ between groups. Long-term graft survival (%) was lower in group 2 and 3 vs group 1 recipients (at 10 years: 51 and 48 vs 56, p = 0.052, respectively). Similarly, freedom from chronic lung allograft dysfunction (CLAD, %) was lower in group 2 and 3 vs group 1 recipients (at 10 years: 57 and 55 vs 63, p = 0.033, respectively). Donor smoking history was associated with worse CLAD-free survival (hazard ratio = 1.466, 95% confidence interval = 1.215-1.769, p < 0.001).

Conclusions: ECD lungs represented an important resource in lung transplantation. However, their use may be associated with a worse long-term graft and CLAD-free survival.

Keywords: Eurotransplant score; donor quality; extended-criteria lung donor; lung transplantation.

Figure 1

The competing-risk factor analysis for CLAD. The orange represents the patient fraction who died without having experienced CLAD. The height of the yellow stripe shows the fraction of patients who have experienced the named event, and the light blue shows the percentage of patients without the event at the time indicated at the x axis. CLAD, chronic lung allograft dysfunction.