Impact of donor organ quality on recipient outcomes in lung transplantation: 14-Year single-center experience using the Eurotransplant lung donor score
Katharina Flöthmann,
Nunzio Davide de Manna, MD,
Khalil Aburahma, MD,
Sophie Kruszona,
Philipp Wand, MD,
Dmitry Bobylev, MD,
Carsten Müller, MD,
Julia Carlens, MD,
Nicolaus Schwerk, MD,
Murat Avsar, MD,
Arjang Ruhparwar, MD,
Christian Kühn, MD,
Mark Greer, MD,
Jawad Salman, MD,
Fabio Ius, MD
Affiliations
Katharina Flöthmann
Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
Nunzio Davide de Manna, MD
Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
Khalil Aburahma, MD
Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
Sophie Kruszona
Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
Philipp Wand, MD
Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
Dmitry Bobylev, MD
Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
Carsten Müller, MD
Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
Julia Carlens, MD
Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
Nicolaus Schwerk, MD
Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
Murat Avsar, MD
Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
Arjang Ruhparwar, MD
Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany; German Center for Lung Research (DZL/BREATH), Hannover, Germany
Christian Kühn, MD
Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany; German Center for Lung Research (DZL/BREATH), Hannover, Germany
Mark Greer, MD
Department of Respiratory Medicine and Infectious Diseases, Hannover Medical School, Hannover, Germany; German Center for Lung Research (DZL/BREATH), Hannover, Germany
Jawad Salman, MD
Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
Fabio Ius, MD
Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany; Corresponding author: Fabio Ius, MD, Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Carl-Neuberg Strasse 1, 30625 Hannover, Germany.
Background: The use of extended-criteria donor (ECD) organs has increased in lung transplantation, but their impact on long-term outcomes remains unclear. This retrospective single-center study evaluates the impact of donor quality, as defined by the Eurotransplant (ET) lung donor score, on long-term graft function and survival. Methods: Records of recipients transplanted between January 2010 and May 2023 were reviewed. Eurotransplant lung donor scores (ET scores) were retrospectively calculated from the corresponding donor reports. Outcomes were compared between recipients of donor lungs with an ET score of 6 (group 1), 7 and 8 (group 2), and 9 to 13 (group 3, ECD lungs). Median follow-up was 64 (30-104) months. Results: In total, 280 (19%) patients were transplanted with ET score 6 lungs, 717 (48%) patients with ET scores 7 and 8 lungs, and 506 (34%) patients with ET scores 9 to 13 (ECD) lungs. The occurrence of primary graft dysfunction grade 3 at 72 hours (p = 0.672), duration of mechanical ventilation (p = 0.062), and in-hospital mortality (p = 0.713) did not differ between groups. Long-term graft survival (%) was lower in group 2 and 3 vs group 1 recipients (at 10 years: 51 and 48 vs 56, p = 0.052, respectively). Similarly, freedom from chronic lung allograft dysfunction (CLAD, %) was lower in group 2 and 3 vs group 1 recipients (at 10 years: 57 and 55 vs 63, p = 0.033, respectively). Donor smoking history was associated with worse CLAD-free survival (hazard ratio = 1.466, 95% confidence interval = 1.215-1.769, p < 0.001). Conclusions: ECD lungs represented an important resource in lung transplantation. However, their use may be associated with a worse long-term graft and CLAD-free survival.
