The use of polytrauma donor organs does not impair long-term outcome after lung transplantation

Background:

The use of organs from polytrauma donors is reported to be associated with impaired results. Thus, radiological signs of lung contusions is a clear reason for many centers to reject an organ offer. This results in the loss of potentially viable organs for the donor pool.

Material and method:

We analysed a total of 751 patients who received standard double lung transplantation between January 2010 and June 2018 in our institution. A total of 102 patients were transplanted using lungs from polytrauma donors. These cases were divided into two groups: Group I (n = 46) – polytrauma donors who had radiological signs of lung contusion; Group II (n = 56) – polytrauma donors with a normal chest radiography. A total of 649 transplantations with non-trauma donors were assigned to Group III. Short- and long-term outcomes of the three groups were compared.

Result:

Basic demographic data and preoperative factors of the recipients of the three groups were comparable. Donors in Group I and II were significantly younger with a median of 22 and 36 years, respectively, while median age in Group III was 44 years (p < 0.001). Secretions in bronchoscopy were found significantly more often in Group I (47.6%) compared to the other groups (p = 0.012). Donors had similar pO2 and pCO2 at 100% FiO2 (p = 0.504) and comparable duration of mechanical ventilation (p = 0.729). Rates of PGD 3 post-transplant were comparable in the three groups (t24: 0.0% vs. 0.0% vs. 2.9%, p = 0.241; t48: 2.3% vs. 0.0% vs. 3.0%, p = 0.438; t72: 0.0% vs. 0.0% vs. 2.9%, p = 0.246). Median length of ventilation was similar with 45 (IQR 54) vs. 34 (IQR 53) vs. 41 (IQR 69) hours (p = 0.374). Also, long-term survival did not appear impaired in the trauma groups (5 years: 78.7% vs. 89.0% vs. 75.1%, p = 0.197).

Conclusion:

Lung transplantation using organs from polytrauma donors leads to comparable short- and long-term results compared to non-trauma donors. The presence or absence of radiological signs of lung contusion did not impact primary graft function and survival.