Anton Sabashnikov1, Nikhil P Patil2, Prashant N Mohite2, Diana García Sáez2, Bartlomiej Zych2, Aron-Frederik Popov2, Alexander Weymann2, Thorsten Wahlers3, Fabio De Robertis2, Toufan Bahrami2, Mohamed Amrani2, André R Simon2. 1. Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Harefield, Middlesex, United Kingdom; Department of Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Germany. Electronic address: a.sabashnikov@rbht.nhs.uk. 2. Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Harefield, Middlesex, United Kingdom. 3. Department of Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Germany.
Abstract
BACKGROUND: Lung transplantation (LTx) is significantly limited by donor organ shortage. Donor smoking history of more than 20 pack-years is considered an extended donor criterion. In this study, we retrospectively evaluated impact of donor smoking history and extent of smoking on midterm outcome after LTx. METHODS: In all, 237 LTx were performed in our institution between 2007 and 2012. Patients were divided into three groups, receiving lungs from 53% nonsmoking donors, 29% smoking donors with fewer than 20 pack-years, and 18% heavy smokers with more than 20 pack-years. RESULTS: Preoperative donor and recipient characteristics among the groups were comparable. However, donors from the heavy smokers group were significantly older (p < 0.001). The overall presence of abnormal histology (inflammation or metaplasia) in donor main bronchi samples increased with the extent of smoking but did not reach statistical significance (p = 0.211). Although metaplasia was found in significantly more donors from the heavy smokers group (p = 0.037), this did not translate into inferior outcomes for the recipients. There were no statistically significant differences in PaO2/FiO2 ratio after LTx, duration of mechanical ventilation (p = 0.136), intensive care unit stay (p = 0.133), and total postoperative hospital stay (p = 0.322). One-year and three-year survival were comparable across all three groups (log rank p = 0.151). Prevalence of bronchiolitis obliterans syndrome (p = 0.616), as well as bronchiolitis obliterans syndrome free survival (p = 0.898) after LTx were also comparable. CONCLUSIONS: In our experience, history and extent of donor smoking do not significantly affect early and midterm outcomes after LTx. Although this finding does not obviate the need for longer-term observation, donor lungs from even heavy smokers may not per se contraindicate LTx and may provide a valuable avenue for expanding donor organ availability.
BACKGROUND: Lung transplantation (LTx) is significantly limited by donor organ shortage. Donor smoking history of more than 20 pack-years is considered an extended donor criterion. In this study, we retrospectively evaluated impact of donor smoking history and extent of smoking on midterm outcome after LTx. METHODS: In all, 237 LTx were performed in our institution between 2007 and 2012. Patients were divided into three groups, receiving lungs from 53% nonsmoking donors, 29% smoking donors with fewer than 20 pack-years, and 18% heavy smokers with more than 20 pack-years. RESULTS: Preoperative donor and recipient characteristics among the groups were comparable. However, donors from the heavy smokers group were significantly older (p < 0.001). The overall presence of abnormal histology (inflammation or metaplasia) in donor main bronchi samples increased with the extent of smoking but did not reach statistical significance (p = 0.211). Although metaplasia was found in significantly more donors from the heavy smokers group (p = 0.037), this did not translate into inferior outcomes for the recipients. There were no statistically significant differences in PaO2/FiO2 ratio after LTx, duration of mechanical ventilation (p = 0.136), intensive care unit stay (p = 0.133), and total postoperative hospital stay (p = 0.322). One-year and three-year survival were comparable across all three groups (log rank p = 0.151). Prevalence of bronchiolitis obliterans syndrome (p = 0.616), as well as bronchiolitis obliterans syndrome free survival (p = 0.898) after LTx were also comparable. CONCLUSIONS: In our experience, history and extent of donor smoking do not significantly affect early and midterm outcomes after LTx. Although this finding does not obviate the need for longer-term observation, donor lungs from even heavy smokers may not per se contraindicate LTx and may provide a valuable avenue for expanding donor organ availability.
Authors: Alexander Weymann; Bastian Schmack; Anton Sabashnikov; Christopher T Bowles; Philipp Raake; Rawa Arif; Markus Verch; Ursula Tochtermann; Jens Roggenbach; Aron Frederik Popov; Andre Ruediger Simon; Matthias Karck; Arjang Ruhparwar Journal: J Cardiothorac Surg Date: 2014-03-29 Impact factor: 1.637
Authors: Anton Sabashnikov; Mohamed Zeriouh; Prashant N Mohite; Nikhil P Patil; Diana García-Sáez; Bastian Schmack; Simona Soresi; Pascal M Dohmen; Aron-Frederik Popov; Alexander Weymann; André R Simon; Fabio De Robertis Journal: Med Sci Monit Basic Res Date: 2016-07-13