Korean J Transplant.  2020 Sep;34(3):185-192. 10.4285/kjt.2020.34.3.185.

Impact of extended-criteria donor lungs according to preoperative recipient status and age in lung transplantation

• Suh JW
• Lee JG
• Park MS
• Kim SY
• Jeong SJ
• Paik HC

• KMID: 2507163
• DOI: http://doi.org/10.4285/kjt.2020.34.3.185

Abstract

Background
Organ donor shortage remains as one of the limiting factors for lung transplantation. Given the increase in waiting time, preoperative condition has worsened and affects surgical outcomes. This study aimed to evaluate the immediate postoperative and long-term outcomes of lung transplantation in extended-criteria donor (ECD) lungs compared with standard-criteria donor (SCD) lungs.
Methods
A total of 246 patients who had undergone double-lung transplantation during the study period were enrolled. SCD was defined based on the following characteristics: age <55 years, <20 pack-years smoking history, and PaO 2 /fraction of O 2 ratio >300 mmHg. Organ donors who do not fulfill these criteria were classified as ECD. Pre- and postoperative data for outcomes and survival data were analyzed.
Results
ECD showed significant association with extracorporeal membrane oxygenation weaning in the operating room (hazard ratio [HR], 0.531; 95% confidence interval [CI], 0.291–0.970; P=0.039) considering recipient’s age and status at operation. The ECD group showed comparable survival rate with the SCD group (HR, 1.413; 95% CI, 0.885– 2.255; P=0.148), with adjustment of other factors. However, when the recipient had Korean Network for Organ Sharing (KONOS) status 0 at the time of transplantation (HR, 1.662; 95% CI, 1.025–2.568; P=0.039), G3 primary graft dysfunction at 72 hours after surgery (HR, 2.508; 95% CI, 1.416–4.440; P=0.002) was a risk factor that decreased survival.
Conclusions
The outcome of ECD is not inferior to that of SCD. Therefore, ECD lung should be considered a potential donor organ following active donor management rather than a contraindication of transplantation in highly selected recipients.

Keyword

Lung transplantation; Donor; Extended criteria donor

Figure

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  Fig. 1 Overall survival. SCD, standard-criteria donor; ECD, extended-criteria donor.

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  Fig. 2 Survival rate according to recipients aged >65 years and donor group. R_age, recipient age. a)P-value between the standard-criteria donor (SCD) group and extended-criteria donor (ECD) group among recipients aged >65 years; b)P-value between recipients aged >65 years and >65 years in the ECD group.

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  Fig. 3 Survival rate according to recipients with Korean Network for Organ Sharing (KONOS) status 0 at transplantation and donor group. a)P-value between the standard-criteria donor (SCD) group and extended-criteria donor (ECD) group of recipients with status 0 at transplantation; b)P-value between recipients with status 0 at transplantation and no status 0 at transplantation in the ECD group.

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