Ian G Christie1, Ernest G Chan1, John P Ryan1, Takashi Harano1, Matthew Morrell2, James D Luketich1, Pablo G Sanchez3. 1. Division of Lung Transplant and Lung Failure, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center; Pittsburgh, Pennsylvania. 2. Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh Medical Center; Pittsburgh, Pennsylvania. 3. Division of Lung Transplant and Lung Failure, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center; Pittsburgh, Pennsylvania. Electronic address: sanchezpg@upmc.edu.
Abstract
BACKGROUND: Extended criteria donor (ECD) for lung transplantation (LTx) have been implemented due to the donor organ shortage. The impact on recipient survival is under investigation. We report trends in the use of extended criteria lungs in the modern era and its association with survival outcomes using a large national database. METHODS: We performed a retrospective analysis of all adult LTx from May 2005 to December 2018 using the United Network for Organ Sharing database. ECD were defined by 2 or more variances from standard criteria: age ≥ 55 years, pO2 ≤ 300, pack years ≥ 20, diabetes, purulent bronchoscopy, blood infection, or abnormal chest radiographs. Transplant centers were dichotomized based on volume. Recipient survival was analyzed using lung allocation score as a covariate. RESULTS: Of 24,888 LTx, 80% had extended criteria; 42% had 2 or more extensions and were deemed ECD in this analysis. Both LTx volume (2005: 1352; 2018: 2495) and use of ECD (2005: 27% ECD, 2018: 50% ECD) have increased over the study period. Survival of LTx recipients has steadily increased (2005: 82% 1-year survival in 2005; 2017: 90% 1-year survival). High-volume centers (>47 annual LTx) utilized ECD in 46% of transplants compared with 40% ECD among other centers. Recipients of ECD and standard criteria organs had no difference in 1-year survival. CONCLUSIONS: Donor supply limits the number of LTx performed. Extension of donor criteria has occurred alongside increased overall LTx volume. Use of ECD did not compromise 30-day, 90-day, nor 1-year survival. Further studies are warranted to define long-term outcomes.
BACKGROUND: Extended criteria donor (ECD) for lung transplantation (LTx) have been implemented due to the donor organ shortage. The impact on recipient survival is under investigation. We report trends in the use of extended criteria lungs in the modern era and its association with survival outcomes using a large national database. METHODS: We performed a retrospective analysis of all adult LTx from May 2005 to December 2018 using the United Network for Organ Sharing database. ECD were defined by 2 or more variances from standard criteria: age ≥ 55 years, pO2 ≤ 300, pack years ≥ 20, diabetes, purulent bronchoscopy, blood infection, or abnormal chest radiographs. Transplant centers were dichotomized based on volume. Recipient survival was analyzed using lung allocation score as a covariate. RESULTS: Of 24,888 LTx, 80% had extended criteria; 42% had 2 or more extensions and were deemed ECD in this analysis. Both LTx volume (2005: 1352; 2018: 2495) and use of ECD (2005: 27% ECD, 2018: 50% ECD) have increased over the study period. Survival of LTx recipients has steadily increased (2005: 82% 1-year survival in 2005; 2017: 90% 1-year survival). High-volume centers (>47 annual LTx) utilized ECD in 46% of transplants compared with 40% ECD among other centers. Recipients of ECD and standard criteria organs had no difference in 1-year survival. CONCLUSIONS: Donor supply limits the number of LTx performed. Extension of donor criteria has occurred alongside increased overall LTx volume. Use of ECD did not compromise 30-day, 90-day, nor 1-year survival. Further studies are warranted to define long-term outcomes.
Authors: Francis T Delaney; John G Murray; Barry D Hutchinson; Jim J Egan; Michelle Murray; Sara Winward; Nicola Ronan; Carmel G Cronin Journal: Eur Radiol Date: 2022-06-16 Impact factor: 5.315
Authors: Maximilian J Roesel; Nirmal S Sharma; Andreas Schroeter; Tomohisa Matsunaga; Yao Xiao; Hao Zhou; Stefan G Tullius Journal: Front Immunol Date: 2022-05-24 Impact factor: 8.786
Authors: Zhizhou Yang; William D Gerull; Hailey M Shepherd; Gary F Marklin; Tsuyoshi Takahashi; Bryan F Meyers; Benjamin D Kozower; G Alexander Patterson; Ruben G Nava; Ramsey R Hachem; Chad A Witt; Derek E Byers; Rodrigo Vazquez Guillamet; Michael K Pasque; Yan Yan; Daniel Kreisel; Varun Puri Journal: Am J Transplant Date: 2021-03-11 Impact factor: 9.369