Donor Alcohol Abuse Increases the Risk for Graft Dysfunction in Lung Transplant Recipients

Abstract

Purpose Primary graft dysfunction (PGD) is a form of ischemia reperfusion lung injury that is a major cause of early morbidity and mortality after lung transplantation. Alcohol abuse is known to alter pulmonary immunity, promote alveolar epithelial dysfunction and increase the risk of acute lung injury. The effects of alcohol abuse in donors of lung allografts on transplant outcomes is unknown, and our aim was to examine the incidence of donor alcohol abuse and early effects on graft function following transplantation. Methods and Materials We performed a single center cohort study of lung transplant recipients from 2007-2011, reviewing patient charts for donor information and lung transplant outcome data. Statistical analysis included student’s t-test and Mann-Whitney U test. Results 195 lung transplant recipients were included in the cohort and 20.5% (N=40) of the recipients had donors with significant alcohol use. Recipients of allografts from alcoholic donors spent more time on mechanical ventilation following transplant when compared to recipients whose donors had no reported alcohol abuse, mean 6.9±12.1 days versus 3.9±8.1 days on the ventilator, (p=0.07). Gas exchange, represented as PaO2/FiO2, was significantly worse in recipients of donors with alcohol abuse following transplant compared to recipients with no donor alcohol abuse ( Fig 1 ). Conclusions Lung transplant recipients who received allografts from alcoholic donors had evidence of graft dysfunction following transplant. We speculate that alcoholic donor allografts may be susceptible to damage from formation of reactive oxygen species, which is exaggerated by the ischemia-reperfusion of transplantation, resulting in an increased rate of PGD.