Lung Transplant Outcomes with Concomitant Heart Donation

Abstract

<h3>Purpose</h3> Concomitant heart and lung donation may adversely affect outcomes in lung transplant recipients. In this study we characterized donor characteristics and examined the outcomes of lung transplantation from donors with concomitant heart donation. <h3>Methods</h3> This retrospective cohort study used the UNOS SRTR database and identified donors as lung only (LO) or heart and lung (HL) donors. Recipients from 5/01/05-03/31/19 were identified and compared. Redo and multi-organ transplants were excluded. Characteristics and outcomes were compared using the Kruskal-Wallis and chi-square tests. Survival was analyzed with Kaplan-Meier analysis and Cox proportional-hazard (CPH) model. <h3>Results</h3> We identified 24,393 lung transplant recipients. 6,412 were in the HL group and 17,981 in the LO donor group. HL recipients were older, male, and had shorter waitlist times (Table, p<0.01 for all). HL donors were younger and had a significantly lower incidence of coronary disease, smoking, diabetes, and hypertension (Table, p<0.01 for all). HL recipients were more likely to be single lung transplants, have shorter ischemic times, and have shorter length of stay (Table, p<0.01 for all). No significant difference in survival was noted with unadjusted analysis (p=0.09), or with the CPH (HL hazard ratio 0.956, 95% confidence interval 0.91-1.00, p=0.06). <h3>Conclusion</h3> No survival difference was noted in recipients of LO and HL donors. Given comparable survival outcomes HL donors should be viewed as equivalent to LO donors. Further investigation should be directed into the reasons behind increased use of single lung transplantation of HL donors and whether both lungs are utilized.