Characterizing the Landscape of Non-Ideal Lungs in the US

Abstract

Purpose Non-ideal donor lungs are defined as those failing to meet ≥1 ISHLT ideal donor criteria (P/F ratio > 300, age Methods We used SRTR data to identify all adult lung offers from 2005-2018. We used adjusted multi-level logistic regression to quantify temporal trends in utilization and discard rates for non-ideal donor lungs, accounting for donor characteristics and center-level variation. We used adjusted Cox regression to characterize temporal trends in mortality for recipients. Results We identified 133,649 lungs offered for transplant, 108,828 (81.4%) of which were not recovered. Of 24,821 lungs recovered, 78.9% came from non-ideal donors. In 2005, 4.9% of non-ideal lungs were discarded versus 8.6% in 2018 (p Conclusion Recipients of non-ideal donor lungs have experienced rates of mortality equivalent to their ideal counterparts and their outcomes have improved over time. Non-ideal lungs are more likely to be discarded despite the vast majority of recovered lungs failing to meet ISHLT ideal donor criteria. Fully 81.4% of lung offered were not recovered. Future work should define a ‘high-risk’ donor lung which more consistently confers greater risk to its recipients as well as strategies to improve recovery.