LUNG DONOR MANAGEMENT STRATEGY IN LUNG TRANSPLANTATION

Abstract

P95 Aims: It is an important issue to expand the number of potential lung donor. Unfortunately, 7 to 22% of multiorgan donors are suitable to become lung donors, due to this fragility in brain dead donor and to the lung injury due to the trauma. In this study, we investigate the critical factors for lung procurement, retrospectively. Methods: The cohort for this study consisted of 385 organ procurement cases in a Transplant Donor Network of Southern California between January 2002 and May 2003. We reviewed 207 cases (53.7%) considered for lung procurement except 178 cases who was not considered for procurement due to social problems or lung disease and damage themselves. Donors were divided into two groups according to whether or not their lungs were harvested: 50 did (the harvest group) and 157 did not (the non-harvest group). We investigate their average age, sex, donor management periods(days), blood pressure in donor management periods, heart rate, P/F ratio, PCO2, HCO3, PEEP, respiratory rate, abnormal findings in the chest X-ray, blood chemistries, sputum culture, and intravenous administration of steroid. Statistical Analysis : Uni- or Multi-variable logistic regression analysis was used to predict lung harvesting by various factors. The odds ratio (OR) and 95% confidence intervals (CI) are given. Results: Uni-variable logistic regression analysis revealed maximum (OR=1.003, CI:1.001-1.004), minimum(OR=1.008, CI:1.004-1.012), and average P/F ratio(OR=1.009, CI:1.005-1.013), and abnormal findings in the chest X-ray(2.322, CI:1.159-4.655) and maximum heart rate(OR=0.9810, CI:0.965-0.997) to be predictors to transplant. Multi-variable logistic regression analysis revealed only average P/F ratio (OR=1.009, CI: 1.005-1.013). We divided the non harvest group into two groups according to whether or not their P/F ratio were more than 300: 55 did (P/F 300 group) and 102 did not (P/F299 group). There were no predictors in P/F300 and the harvest group in both uni- and multi-variable logistic regression analyses. In P/F299 and the harvest group, univariable logistic regression analysis revealed maximum (OR=1.011, CI: 1.007-1.0015), minimum(OR=1.018, CI: 1.011-1.024, and average P/F ratio(OR=1.022, CI: 1.015-1.029), abnormal findings in the chest X-ray(3.333, CI: 1.564-7.106), maximum heart rate(0.976 CI:0.959-0.993), and maximum (0.934 CI: 0.875-0.998), minimum respiratory rate (0.887, CI: 0.792-0.994) to be predictors to transplant. Multi-variable logistic regression analysis revealed only average P/F ratio (OR=1.022, CI: 1.015-1.029). Conclusions: Average P/F ratio is the most important factor for lung procurement. We suggest that donor management to improve average P/F ratio increase lung transplant.