Donor-Bound Predictors for Primary Graft Function in Lung Transplantation - Results from a Prospective Multicenter Study

Abstract

Purpose Acceptance rates of donor lungs differ substantially among transplant centers. This is mainly due to a lack of standardized functional parameters of the donor lungs, which can predict organ function after lung transplantation (LTx). Methods A prospective evaluation of lung donors were performed in three transplant centers between January 2017 and September 2018. Standardized ventilation settings were used to collect respiratory and hemodynamic parameters at the time of retrieval. Duration of mechanical ventilation after lung transplantation was defined as the primary end-point. Results A total of 151 lung donors were included in the study. Median donor age was 46 (12-80), median intubation time was 3 days (1-34), 44 (29.1%) donors had smoking history and 19 (12.6%) had chest trauma. At time of retrieval median P/F ratio was 413 mmHg (79-650), median dynamic compliance 45 ml/mbar (14-121) and median pCO2 40 (19-77). In 10 (6.6%) cases, purulent secretions were found during bronchoscopy. In 6 (3.9%) cases evaluation with EVLP followed organ retrieval. Median recipient age was 55 (18-69). The indications for LTx were: COPD (n=61, 40.4%), CF (n=38, 25.2%) and ILD (n=30, 19.9%). Median length of mechanical ventilation was 32 hours (range: 4 - 964). At 72 hours only 1 (0.7%) PGD grade 3 was recorded. P/F ratio at time of offer, donor intubation time, smoking history, donor age, P/F ratio and peak pressure at time of retrieval did not correlate with recipient length of mechanical ventilation and hospitalization time. On the contrary, dynamic compliance at the time of retrieval correlated inversely with recipient weaning time (rs= - 0.199, p Conclusion In this multicenter analysis of lung donor parameters and their relevance for early post-transplant outcome, we found that dynamic compliance of donor lungs was the only factor associated with recipient weaning and hospitalization time. This parameter may have the potential to improve organ selection and subsequently increase the donor pool.