Influence of donor characteristics on outcome after lung transplantation : A multicenter study
Résumé
Background: The liberalization of lung-donor criteria and the use of marginal donors have been advocated to face the current shortage of donors in lung transplantation. However, the impact of donor characteristics on the outcome of lung transplantation is still largely unknown. We aimed to determine, on a large cohort of patients, the effect of donors characteristics on short- and long-term outcome of lung transplantation. Methods: Between 1988 and 1998, a total of 785 adult patients underwent single-lung transplantation (n 270), bilateral-lung transplantation (n = 251), and heart-lung transplantation (n = 264) in 7 centers in France. We constructed several multivariate models to assess the relationship between donor characteristics and early gas exchange, duration of mechanical ventilation, and long-term survival after lung transplantation. Results: Among donor characteristics, donor gas exchange before harvest was found to be significantly associated with recipient early gas exchange, duration of mechanical ventilation, and long-term survival after adjustment for potential confounding variables. Moreover, nonlinear modeling showed a steep increase in the relative risk of death when donor Pao(2)/Fio(2) before harvest was below 350 (hazard ratio 1.43; 95% confidence interval 1.10 - 1.85; p = 0.01). Donor and recipient sex mismatch were also found to be significantly associated with long-term survival. Conclusions: Although liberalization of lung-donor criteria may be considered to overcome the shortage of lung donors, our data suggest that the violation of the gas-exchange criterion should be avoided.