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Transplantation |

Survival of Patients With Lung Transplants From Donors With Central Nervous System Tumors FREE TO VIEW

Linh Truong, MD; Alex Balekian, MD
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University of Southern California-LAC+USC, Los Angeles, CA


Chest. 2015;148(4_MeetingAbstracts):1081A. doi:10.1378/chest.2281814
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Abstract

SESSION TITLE: Transplantation Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: Although case reports have described metastatic spread of donor central nervous system (CNS) tumors in other solid organ transplant recipients, the lack of adequate donors for lung transplants would benefit from expanded donor criteria. We aimed to describe the survival of lung transplant patients receiving organs from donors with CNS tumors.

METHODS: Retrospective review of UNOS lung data for all adult (>18 years) patients transplanted between 1994 and 2014. We excluded patients with prior lung transplant. We matched CNS tumor recipients with tumor-free recipients from the same calendar year and performed Kaplan-Meier analysis to compare overall survival. Using Cox proportional hazards, we calculated hazard ratios (HR) for post-transplant overall survival on age, sex, diagnosis, donor cancer status, and transplant type (single vs double), as well as forced vital capacity (FVC), creatinine, and mechanical ventilation (MV) at transplant.

RESULTS: Of the 24,152 patients with complete data, 55% were male, 40% had COPD, 5% had PAH, 14% had CF, and 41% had IPF. 135 patients (0.56%) received an organ from a donor with a CNS tumor. Recipients of lungs from donors with CNS tumors did not differ significantly in age, sex, underlying diagnosis, or disease severity from recipients without CNS tumor donors. The median survival of recipients with and without CNS tumors did not differ (4.6 years vs 5.3 years, p=0.74). After multivariable adjustment for covariates, receipt of a lung from a CNS tumor donor was not associated with post-transplant all-cause mortality (HR 1.03, 95%CI [0.82-1.28], p=0.82). These results were similar after stratifying into subgroups of transplant type (single vs double) and underlying diagnosis.

CONCLUSIONS: Although lungs from donors with CNS tumors are transplanted in fewer than 1% of transplant recipients, their post-transplant survival is comparable. The limited pool of lung donors could be expanded by loosening criteria for procuring organs from donors with CNS tumors.

CLINICAL IMPLICATIONS: By expanding donor criteria to patients with CNS tumors, clinicians can increase transplants and decrease wait list time in patients with end-stage lung disease.

DISCLOSURE: The following authors have nothing to disclose: Linh Truong, Alex Balekian

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