Donor selection for lung transplant in Turkey: Is it necessary to wait for an ideal donor?

Background: The aim of this study was to evaluate the donor criteria used in lung transplantation in our clinic. Methods: A total of 55 cadaveric donors who were accepted for lung transplantation in our clinic between December 2016 and January 2019 were retrospectively analyzed according to ideal donor criteria. The donors were divided into two groups as ideal and non-ideal ones according to their age, partial pressure of oxygen in arterial blood, history of smoking, and ventilation day. Donor data, recipient characteristics and survival outcomes were evaluated. Results: Of 55 donors accepted for lung transplantation, 24 (43.7%) were ideal and 31 (56.3%) were non-ideal donors. The 90-day mortality and one-year survival rates were not significantly different between the two groups. The 90-day mortality was 25% in the ideal group and 22.6% in the non-ideal group (p=0.834). The one-year survival rates after lung transplantation were 64.5% versus 70.6% in the ideal and non-ideal groups, respectively (p=0.444). Conclusion: The whole clinical picture should be evaluated before accepting or rejecting donors for lung transplantation. The use of lung donors that do not meet the ideal criteria does not impair short- and mid-term results, compared to ideal lung donors. Strict implementation of donor criteria may prevent using suitable donors for lung transplantation. Use of non-ideal donors can reduce waiting list mortality.

Türkiye’de akciğer nakli için donör seçimi: İdeal bir donör beklemek gerekir mi?

Amaç: Bu çalışmada kliniğimizde akciğer naklinde kullanılan donör kriterleri değerlendirildi. Çalışma planı: Aralık 2016 - Ocak 2019 tarihleri arasında kliniğimizde akciğer nakli için kabul edilen toplam 55 kadaverik donör ideal donör kriterlerine göre geriye dönük olarak değerlendirildi. Donörler yaşlarına, arteriyel kandaki kısmi oksijen basıncına, sigara öyküsüne ve ventilasyon gününe göre ideal ve ideal olmayanlar olmak üzere iki gruba ayrıldı. Donör verileri, alıcı özellikleri ve sağkalım sonuçları değerlendirildi. Bulgular: Akciğer nakli için kabul edilen 55 donörün 24'ü (%43.7) ideal ve 31'i (%56.3) ideal olmayan dönörler idi. Doksan günlük mortalite ve bir yıllık sağkalım oranları açısından iki grup arasında anlamlı bir fark yoktu. Doksan günlük mortalite ideal grupta %25 iken, ideal olmayan grupta %22.6 idi (p=0.834). Akciğer naklinden sonraki bir yıllık sağkalım oranı, ideal ve ideal olmayan gruplarda sırasıyla %64.5 ve %70.6 idi (p=0.444). Sonuç: Akciğer nakli için donörleri kabul etmeden veya reddetmeden önce tüm klinik tablo değerlendirilmelidir. İdeal kriterleri karşılamayan akciğer donörlerinin kullanılması, ideal akciğer donörleri ile karşılaştırıldığında, kısa ve orta vadeli sonuçları bozmaz. Donör kriterlerinin sıkı uygulanması, akciğer nakli için uygun donörlerin kullanılmasını engelleyebilir. İdeal olmayan donörlerin kullanılması bekleme listesi mortalitesini azaltabilir

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1. United States Organ Transplantation. Organ Procurement and Transplantation Network & Scientific Registry of Transplant Recipient Annual Report 2017. Available at: https://srtr.transplant.hrsa.gov/annual_reports/2017_ADR_ Preview.aspx.
2. Bennett D, Fossi A, Bargagli E, Refini RM, Pieroni M, Luzzi L, et al. Mortality on the waiting list for lung transplantation in patients with idiopathic pulmonary fibrosis: A single- centre experience. Lung 2015;193:677-81.
3. Straznicka M, Follette DM, Eisner MD, Roberts PF, Menza RL, Babcock WD. Aggressive management of lung donors classified as unacceptable: Excellent recipient survival one year after transplantation. J Thorac Cardiovasc Surg 2002;124:250-8.
4. Botha P, Trivedi D, Weir CJ, Searl CP, Corris PA, Dark JH, et al. Extended donor criteria in lung transplantation: Impact on organ allocation. J Thorac Cardiovasc Surg 2006;131:1154-60.
5. Chaney J, Suzuki Y, Cantu E 3rd, van Berkel V. Lung donor selection criteria. J Thorac Dis 2014;6:1032-8.
6. Botha P, Rostron AJ, Fisher AJ, Dark JH. Current strategies in donor selection and management. Semin Thorac Cardiovasc Surg 2008;20:143-51.
7. Singh E, Schecter M, Towe C, Rizwan R, Roosevelt B, Tweddell J, et al. Sequence of refusals for donor quality, organ utilization, and survival after lung transplantation. J Heart Lung Transplant 2019;38:35-42.
8. Akciğer nakilleri: Avaible at: https://organkds.saglik.gov.tr/ dss/PUBLIC/Transplant_Lung.aspx.
9. Yeginsu A, Kalamanoğlu Balcı M, Vayvada M, Erkılınç A, Kutlu CA. Akciğer naklinde vücut dışında akciğer perfüzyonu: Olgu sunumu. Turk Gogus Kalp Dama 2016;24:144-7.
10. Baldwin MR, Peterson ER, Easthausen I, Quintanilla I, Colago E, Sonett JR, et al. Donor age and early graft failure after lung transplantation: A cohort study. Am J Transplant 2013;13:2685-95.
11. Hecker M, Hecker A, Kramm T, Askevold I, Kuhnert S, Reichert M, et al. Use of very old donors for lung transplantation: A dual-centre retrospective analysis. Eur J Cardiothorac Surg 2017;52:1049-54.
12. Taghavi S, Jayarajan S, Komaroff E, Horai T, Brann S, Cordova F, et al. Double-lung transplantation can be safely performed using donors with heavy smoking history. Ann Thorac Surg 2013;95:1912-7.
13. Schultz HH, Møller CH, Zemtsovski M, Ravn J, Perch M, Martinussen T, et al. Donor smoking and older age increases morbidity and mortality after lung transplantation. Transplant Proc 2017;49:2161-8.
14. Gabbay E, Williams TJ, Griffiths AP, Macfarlane LM, Kotsimbos TC, Esmore DS, et al. Maximizing the utilization of donor organs offered for lung transplantation. Am J Respir Crit Care Med 1999;160:265-71.
15. Whitford H, Kure CE, Henriksen A, Hobson J, Snell GI, Levvey BJ, et al. A donor PaO2/FiO2 < 300 mm Hg does not determine graft function or survival after lung transplantation. The Journal of Heart and Lung Transplantation 2020;39:53-61.
16. Zafar F, Khan MS, Heinle JS, Adachi I, McKenzie ED, Schecter MG, et al. Does donor arterial partial pressure of oxygen affect outcomes after lung transplantation? A review of more than 12,000 lung transplants. J Thorac Cardiovasc Surg 2012;143:919-25.
17. Weill D, Dey GC, Hicks RA, Young KR Jr, Zorn GL Jr, Kirklin JK, et al. A positive donor gram stain does not predict outcome following lung transplantation. J Heart Lung Transplant 2002;21:555-8.
18. Serpa Neto A, Cardoso SO, Manetta JA, Pereira VG, Espósito DC, Pasqualucci Mde O, et al. Association between use of lung-protective ventilation with lower tidal volumes and clinical outcomes among patients without acute respiratory distress syndrome: A meta-analysis. JAMA 2012;308:1651-9.
19. Bansal R, Esan A, Hess D, Angel LF, Levine SM, George T, et al. Mechanical ventilatory support in potential lung donor patients. Chest 2014;146:220-7.
20. Elmer A, Birrer M, Weiss J, Aubert JD, Benden C, Inci I, et al. Extended-criteria donors in lung transplantation in Switzerland: An evaluation of two adapted lung donor scores. Swiss Med Wkly 2018;148:w14614.