The primary limiting factor to lung transplantation is the shortage of donor lungs. A number of single center studies have suggested that the use of extended donor criteria may improve the donor supply and decrease waiting times without compromising outcomes. Despite these encouraging results, the use of extended donors is still a controversial issue. We report our center’s outcomes using extended vs. standard donor.
We reviewed records of lung donors selected for transplant at UTHSCSA from 9/26/02 to 4/30/03 characterizing them as an extended (group I) vs. standard donor (Group II). Donors were considered extended if any of the following criteria were met: Age > 55 years, smoking > 20 pack years, PaO2/Fi02 ratio <300, CXR infiltrate, purulent secretions on bronchoscopy or history of pulmonary disease. We then reviewed the early outcomes and spirometry of each recipient to evaluate potential consequences of using extended donor lungs. Outcomes evaluated were total length of stay (LOS), ICU LOS, length of intubation, 30-day mortality, and FEV1 (6 and 12 months) post-transplant.
Both groups had similar pre-transplant diagnoses and transplant type.
Our center’s results are similar to those of other studies showing that outcomes were no different when using extended vs. standard donors. This has allowed us to decrease the waiting time in our program considerably without compromising outcomes of the recipients.IMPLICATIONS: Because the supply of donor lungs is so limited, it is important to create new standardized donor criteria, which reflect the current experience of and clinical practice at some lung transplant centers. Moreover, the results of using extended donor criteria should be incorporated into a national database so that the clinical outcomes could be evaluated in a multi-center prospective manner.
Group 1*Group II*p valueNumber of patients2011Waiting time64 +/− 2542 +/− 130.08Total LOS11.5 +/− 49 +/− 1.480.065ICU LOS4 +/− 2.73 +/− 0.890.08Length of intubation2 +/− 2.761 +/− 0.530.17Re-Admissions1.0 +/− 0.360.5 +/− 0.370.27FEV1 (6 months)1.64 +/− 0.11.99 +/− 0.60.29FEV1 (12 months)1.74 +/− 0.242.35 +/− 0.30.2130 day mortality00* Results are median +/− Standard Error
D. Levine, None.