The use of non-heart-beating lung donors category III can increase the donor pool

• Published in: European journal of cardio-thoracic surgery Vol. 39; no. 6; pp. e175 - e180
• Main Authors: Van De Wauwer, Caroline, Verschuuren, Erik A.M., van der Bij, Wim, Nossent, George D., Erasmus, Michiel E.
• Format: Journal Article
• Language: English
• Published: Germany Elsevier Science B.V 01.06.2011
• Subjects: Acute Disease; Adult; Bronchiolitis Obliterans - etiology; Donor Selection - methods; Female; Forced Expiratory Volume - physiology; Graft Rejection; Heart Arrest; Humans; Kaplan-Meier Estimate; Lung Transplantation - adverse effects; Lung Transplantation - methods; Lung Transplantation - physiology; Male; Middle Aged; Organ Preservation - methods; Retrospective Studies; Tissue and Organ Harvesting - methods; Tissue and Organ Procurement - methods; Treatment Outcome; Primary graft dysfunction; Non-heart-beating donor; Lung transplantation
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/j.ejcts.2011.01.035

Abstract Objective: The use of non-heart-beating (NHB) lung donors has been propagated as an alternative besides heart-beating (HB) lung donors to overcome organ shortage. We evaluated the effectiveness of NHB lung transplantation Methods: The donor and recipient data of all 35 NHB category III lung transplantations (LTx) between January 2005 and December 2009 were reviewed. For comparison, we collected recipient and donor data of a cohort of 77 HB lung transplantations. In both groups, we assessed survival, primary graft dysfunction (PGD), forced expiratory volume in 1 s (FEV1), acute rejection, and bronchiolitis obliterans syndrome (BOS). Results: Thirty-five NHB lung transplantations were performed, five single LTx and 30 bilateral LTx in 12 male and 23 female patients. The donor oxygenation capacity was 61 kPa (interquartile range (IQR), 56-64). Warm ischemia time in the donor was 29 min (IQR, 24-30). Cold ischemic time of the last implanted lung was 458 min (IQR, 392-522). Cardiopulmonary bypass was used 13 times. PGD (1-3) was observed in 45% of the patients at T0, in 42% at T24, in 53% at T48, and in 50% at T72. PGD 3 decreased from 24% at T0 to 6% at T72. The use of nitric oxide (NO) within 24 h after transplantation was necessary in three patients with successful weaning in all. There was no significant difference for donor and recipient characteristics between NHB and HB lung transplantations. Survival, occurrence of PGD, and acute rejection was equal to the HB cohort. The incidence of BOS was lower in the NHB group. The measured FEV1 tended to be better in the NHB group. Conclusion: Lungs from nonheparinized category III NHB donors are well suited for transplantation and can safely increase the donor pool.