Sequence of refusals for donor quality, organ utilization, and survival after lung transplantation.
donor quality
donor refusal
lung transplant
lung transplant survival
organ utilization
Journal
The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation
ISSN: 1557-3117
Titre abrégé: J Heart Lung Transplant
Pays: United States
ID NLM: 9102703
Informations de publication
Date de publication:
01 2019
01 2019
Historique:
received:
14
04
2018
revised:
12
08
2018
accepted:
13
08
2018
pubmed:
23
9
2018
medline:
26
12
2019
entrez:
23
9
2018
Statut:
ppublish
Résumé
Lung donor utilization rates remain low, with many organs refused for donor quality. However, some centers have successfully transplanted these organs despite multiple refusals for donor quality (RDQs) by other centers. We hypothesized that the number of refusals due to donor quality does not impact post-transplant outcomes. Lung transplants (LTxs) from 2006 to 2015, identified using the United Network for Organ Sharing (UNOS) database, were matched against the potential transplant recipient (PTR) data set by donor identification. Transplants were categorized into 2 groups: low RDQ (0 to 3 RDQs) and high RDQ (>3 RDQs). Post-transplant survival and predictors for high RDQ were observed using Kaplan‒Meier and logistic regression analyses, respectively. Of 10,126 adult (>18 years) LTxs, 77% had at least 1 RDQ, with a median of 4 RDQs. Post-transplant 1-year survival was similar for both the low and high RDQ groups (p = 0.49). Furthermore, groups of recipients who received donors with an increasing number of RDQs (>3, >6, or >10) also had similar post-transplant 1-year survival (p = 0.77). Treatment for rejection within 1 year and intubation at 72 hours post-transplant were higher in the high RDQ group (p < 0.01). An inverse relationship was identified between the number of RDQs and likelihood of utilization. After 10 RDQs, the likelihood of utilization varied significantly by donor characteristics. Lung transplant survival is not associated with number of refusals due to donor quality. When determining whether an organ is suitable for transplant, the number of refusals due to donor quality should not influence one's decision, especially in this era of limited donor supply.
Sections du résumé
BACKGROUND
Lung donor utilization rates remain low, with many organs refused for donor quality. However, some centers have successfully transplanted these organs despite multiple refusals for donor quality (RDQs) by other centers. We hypothesized that the number of refusals due to donor quality does not impact post-transplant outcomes.
METHODS
Lung transplants (LTxs) from 2006 to 2015, identified using the United Network for Organ Sharing (UNOS) database, were matched against the potential transplant recipient (PTR) data set by donor identification. Transplants were categorized into 2 groups: low RDQ (0 to 3 RDQs) and high RDQ (>3 RDQs). Post-transplant survival and predictors for high RDQ were observed using Kaplan‒Meier and logistic regression analyses, respectively.
RESULTS
Of 10,126 adult (>18 years) LTxs, 77% had at least 1 RDQ, with a median of 4 RDQs. Post-transplant 1-year survival was similar for both the low and high RDQ groups (p = 0.49). Furthermore, groups of recipients who received donors with an increasing number of RDQs (>3, >6, or >10) also had similar post-transplant 1-year survival (p = 0.77). Treatment for rejection within 1 year and intubation at 72 hours post-transplant were higher in the high RDQ group (p < 0.01). An inverse relationship was identified between the number of RDQs and likelihood of utilization. After 10 RDQs, the likelihood of utilization varied significantly by donor characteristics.
CONCLUSIONS
Lung transplant survival is not associated with number of refusals due to donor quality. When determining whether an organ is suitable for transplant, the number of refusals due to donor quality should not influence one's decision, especially in this era of limited donor supply.
Identifiants
pubmed: 30241885
pii: S1053-2498(18)31601-2
doi: 10.1016/j.healun.2018.08.009
pmc: PMC6298809
mid: NIHMS1507316
pii:
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
35-42Subventions
Organisme : NHLBI NIH HHS
ID : R21 HL135306
Pays : United States
Organisme : NHLBI NIH HHS
ID : T35 HL113229
Pays : United States
Informations de copyright
Copyright © 2018 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.
Références
Am J Transplant. 2013 Oct;13(10):2685-95
pubmed: 24034167
Dtsch Arztebl Int. 2014 Feb 14;111(7):107-16
pubmed: 24622680
Transpl Int. 2010 Jun;23(6):628-35
pubmed: 20059752
Am J Transplant. 2003 Nov;3(11):1400-6
pubmed: 14525601
Curr Pulmonol Rep. 2016;5:152-158
pubmed: 27610336
Am J Transplant. 2017 Jan;17 Suppl 1:357-424
pubmed: 28052607
Am J Respir Crit Care Med. 1999 Jul;160(1):265-71
pubmed: 10390410
Eur J Cardiothorac Surg. 2014 Dec;46(6):e82-8
pubmed: 25342851
Curr Opin Organ Transplant. 2009 Apr;14(2):206-10
pubmed: 19469042
J Thorac Cardiovasc Surg. 2009 Nov;138(5):1234-1238.e1
pubmed: 19837222
Am J Transplant. 2005 Apr;5(4 Pt 2):862-73
pubmed: 15760414
Transpl Int. 2014 Nov;27(11):1183-91
pubmed: 25070600
Am J Respir Crit Care Med. 2013 Mar 1;187(5):527-34
pubmed: 23306540
Am J Transplant. 2017 Jan;17 Suppl 1:11-20
pubmed: 28052601
J Thorac Cardiovasc Surg. 2004 May;127(5):1493-501
pubmed: 15116013