Impact of Donor Quality on Recipient Outcomes in Lung Transplantation: 11-Year Single-Center Experience Using the Eurotransplant Lung Donor Score

Background: Although use of extended criteria donor organs (ECD) has increased in lung transplantation, their impact on outcomes remains unclear. The Eurotransplant (ET) lung donor score (ELDS) was designed to classify lung donor quality, taking into account donor history, tobacco exposure, age, arterial blood gases, chest X-ray and bronchoscopic findings. This retrospective single-center study evaluates the impact of ECD on graft function and survival.

Method: Records of lung allograft recipients transplanted at our institution between 01/2010 and 08/2021 were reviewed. Individual ELDSs were calculated from the corresponding ET donor reports. Outcomes were compared between recipients of ideal donors (ELDS 6, Group 1), of intermediate-risk donors (ELDS 7–8, Group 2), and of extended-criteria donors (ELDS 9–15, Group 3). Median (IQR) follow-up was 50 (23–85) months.

Results: In total, 261/1,355 (19.3%) patients received Group 1 donor organs, 679 (50.1%) patients received Group 2 donor organs, and 415 (30.6%) patients received Group 3 donor organs. Group 2 and 3 recipients were older than group 1 recipients (median age, 53 and 54 vs. 44 years, p < 0.001). The need for intraoperative ECMO support (26.8% vs. 29% vs. 26.5%, p = 0.62), occurrence of grade 3 primary graft dysfunction at 72 hours after transplantation (4.7% vs. 4.7% vs. 6.5%, p = 0.39), duration of mechanical ventilation (median 13 vs. 14 vs. 13 hours, p = 0.15), and in-hospital mortality (4.6 vs. 5% vs. 4.1%, p = 0.78) did not differ between Groups 1, 2 and 3, respectively. At 1-year follow-up, no difference in median forced expiratory volume in one second (% predicted) existed between groups 1, 2 and 3 (90 vs. 86 vs. 85, p = 0.23), respectively. At 5 and 8 years, graft survival (%) did not differ significantly between Groups 1, 2 and 3 (5-year: 75 vs. 69 vs. 70; 8-year: 68 vs. 61 vs. 57, p = 0.095), respectively. ECD patients (Group 3) did however exhibit significantly lower 5- and 8-year freedom from chronic lung allograft dysfunction (CLAD, %) compared with those in Group 1 patients (5-year: 63 vs. 72; 8-year: 53 vs. 65, p = 0.008), respectively. In the Cox´s analysis, increasing ELDS was associated with CLAD (HR = 1.075; 95% CI: 1.011–1.144, p = 0.021).

Conclusion: ECD lungs constituted one third of our donor pool. Their use did not negatively impact the recipient survival, but CLAD-free survival was worse in ECD recipients.

Publication History

Article published online:
03 February 2022