Increased-risk versus standard-risk donation in lung transplantation: A United Network of Organ Sharing analysis

Meredith Brown; Mohammed Abul Kashem; Huaqing Zhao; Hiromu Kehara; Roh Yanagida; Norihisa Shigemura; Yoshiya Toyoda

doi:10.1016/j.jtcvs.2023.08.053

Increased-risk versus standard-risk donation in lung transplantation: A United Network of Organ Sharing analysis

J Thorac Cardiovasc Surg. 2023 Sep 7:S0022-5223(23)00768-7. doi: 10.1016/j.jtcvs.2023.08.053. Online ahead of print.

Authors

Meredith Brown¹, Mohammed Abul Kashem², Huaqing Zhao¹, Hiromu Kehara¹, Roh Yanagida¹, Norihisa Shigemura¹, Yoshiya Toyoda¹

Affiliations

¹ Division of Cardiovascular Surgery, Department of Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pa.
² Division of Cardiovascular Surgery, Department of Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pa. Electronic address: m.abul.kashem@tuhs.temple.edu.

PMID: 37689235
DOI: 10.1016/j.jtcvs.2023.08.053

Abstract

Objectives: Donors with characteristics that increase risk of hepatitis B virus, hepatitis C virus, and HIV transmission are deemed increased-risk donors (IRDs) per Public Health Service guidelines. Compared with organs from standard-risk donors (SRDs), IRD organs are more frequently declined. We sought to investigate the outcomes of IRD lung transplant recipients following the 2013 guideline change.

Methods: We retrospectively identified lung transplant recipients using the United Network of Organ Sharing registry (February 2014 to March 2020). Patients were divided into 2 cohorts, based on Centers for Disease Control and Prevention risk status of the donor: SRD or IRD. Demographics and clinical parameters were compared across groups. Survival was compared using Kaplan-Meier curves and log-rank tests. Cox proportional hazard model was performed to identify variables associated with survival outcome.

Results: We identified 13,205 lung transplant recipients, 9963 who received allografts from SRDs and 3242 who received allografts from IRDs. In both groups, most donors were White, male, and <30 years old. IRDs demonstrated greater rates of heavy alcohol, cigarette, and cocaine use. SRDs had greater rates of cancer, hypertension, previous myocardial infarction, and diabetes. Survival analysis demonstrated no significant difference in 90-day, 1-year, 3-year, or 5-year survival outcome between SRD and IRD recipients (P = .34, P = .67, P = .40, P = .52, respectively). Cox regression demonstrated that double-lung transplants were associated with 13% decreased mortality risk compared with single-lung (P = .0009).

Conclusions: IRD and SRD recipients demonstrated equivalent survival outcomes. Our study suggests that IRDs offer a safe approach to expand the donor pool and increase availability of lungs for transplantation.

Keywords: UNOS; increased-risk donor; lung transplantation; outcome.