Chest computed tomography imaging improves potential lung donor assessment

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 157; no. 4; pp. 1711 - 1718.e1
• Main Authors: Gauthier, Jason M., Bierhals, Andrew J., Liu, Jingxia, Balsara, Keki R., Frederiksen, Christine, Gremminger, Emily, Hachem, Ramsey R., Witt, Chad A., Trulock, Elbert P., Byers, Derek E., Yusen, Roger D., Aguilar, Patrick R., Marklin, Gary, Nava, Ruben G., Kozower, Benjamin D., Pasque, Michael K., Meyers, Bryan F., Patterson, G. Alexander, Kreisel, Daniel, Puri, Varun
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2019
• Subjects: Adult; Brain Death - diagnostic imaging; Clinical Decision-Making; Donor Selection; Female; Humans; Lung - diagnostic imaging; lung diseases; Lung Diseases - complications; Lung Diseases - diagnostic imaging; lung transplantation; Lung Transplantation - adverse effects; Lung Transplantation - methods; Male; Middle Aged; organ allocation; Predictive Value of Tests; Retrospective Studies; Risk Assessment; Risk Factors; surgery; Tomography, X-Ray Computed; ILD; lung diseases; LT; organ allocation; MTS; OPO; iPaO2; TLI; CT; PaO2; SDCF; lung transplantation; CXR; surgery; COPD
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2018.11.038

Chest computed tomography (CT) imaging is being increasingly used for potential lung donor assessment. However, the efficacy of CT imaging in this setting remains unknown. We hypothesize that chest CT imaging independently affects the decision-making process in donor lung utilization. We conducted a retrospective cohort study of all adult donation after brain death donors managed through our local organ procurement organization from June 2011 to November 2016. An experienced thoracic radiologist independently reviewed donor chest CT and chest x-ray images in a blinded, standardized manner to determine the presence of structural lung disease (eg, emphysema, interstitial lung disease [ILD]) and acute abnormalities (eg, traumatic lung injury [TLI]). Distinct models of lung utilization were fit to groups with initial partial pressure of oxygen (iPaO2) ≤300 mm Hg (suboptimal) and iPaO2 >300 mm Hg (optimal). The organ procurement organization managed 753 donors during the study period, with a lung utilization rate ([lung donors/all organ donors] × 100) of 36.5% (275 of 753). Four hundred forty-five (59.1%) donors received chest CT imaging, revealing emphysema (13.7%), ILD (2.5%), and TLI (7.2%). In univariate analysis, findings of TLI (odds ratio [OR], 2.23; 95% confidence interval [CI], 1.08-4.61) were positively associated with lung utilization, whereas findings of emphysema (OR, 0.18; CI, 0.08-0.40) were negatively associated with utilization. In multivariate analysis, CT findings of emphysema (OR, 0.21; CI 0.08-0.54) remained negatively associated with utilization. No potential donors with CT findings of ILD became lung donors. After controlling for chest x-ray findings, chest CT imaging findings of structural lung disease remained negatively associated with utilization (P = .0001). Lung utilization rate in the suboptimal and optimal iPaO2 populations was 35.1% and 41.4%, respectively, and CT findings of emphysema had a significant association with nonutilization in both groups. In the evaluation of potential lung donors, chest CT imaging findings of structural lung disease, such as emphysema and ILD, have a significant negative association with lung utilization. Our findings suggest that chest CT imaging might be an important adjunct to conventional lung donor assessment criteria.