PURPOSE: Lung transplant wait-list mortality is primarily driven by availability of donor lungs. Many transplant centers decline lungs from donors with a PaO2/FiO2 (P/F) of below 400. We studied the impact of donor P/F ratio on early outcomes post lung transplantation in a single center cohort.
METHODS: We conducted a retrospective review of records of all lung transplant recipients done in the years June 2005 to January 2007. This cohort was divided by the donor P/F ratio into three groups as follows:P/F less than 350, between 351–400 and more than 400. The primary outcome measure was death at 30 days. The most common recipient diagnoses leading to lung transplant were 1.COPD, 2.Cystic Fibrosis, 3.Pulmonary fibrosis and 4.Pulmonary hypertension. Lung allocation scores for recipients and P/F ratio of donors were among the demographic characteristics that were examined.
RESULTS: The mean donor P/F ratio was 433+/- 73. Death at 30 days post transplant was 0% in the donor P/F< 350 group, 11% in the P/F 351–400 group and 87% in the P/F > 400 group.
CONCLUSION: Death at 30 days post lung transplant did not differ significantly between the groups. The difference between groups in other outcome measures including hospital length of stay, duration of ICU stay, length of mechanical ventilation and recipient P/F ratio at extubation also did not achieve statistical significance.
CLINICAL IMPLICATIONS: Donor P/F ratio acceptability criteria has not been studied in a controlled manner. The value of donor P/F ratio that can be reasonably accepted is still variable among various centers. This may result in rejection of potentially viable organs. In our single center experience a donor P/F ratio below 350 did not adversely affect early post transplant outcomes. The potential of using donor lungs with P/F ratios below the accepted arbitrary norm deserves further investigation.
DISCLOSURE: Rajesh Shetty, None.