Donor Ventilation Parameters as Predictors for Length of Mechanical Ventilation after Lung Transplantation: Results of a Prospective Multicenter Study.

The evaluation of donor lungs heavily depends on the subjective judgment of the retrieval surgeon. As a consequence, acceptance rates vary significantly among transplant centers. We aimed to determine donor ventilation parameters in a prospective study and test if they could be used as objective quality criteria during organ retrieval. A prospective evaluation of lung donors was performed in three transplant centers. Ventilation parameters were collected at the time of retrieval using a standardized ventilation protocol. Recipient length of mechanical ventilation (LMV) was defined as the primary endpoint and collected data was used to build linear models predicting LMV. In total 166 donors were included in this study. Median LMV after transplantation was 32 hours (IQR:20-63). Peak inspiratory pressure (P IP) and dynamic compliance (C dyn) at the time of retrieval but not P/F ratio correlated with recipient LMV in Spearman correlations (r=0.280, p=0.002; r=-0.245, p=0.003 and r=0.064, p=0.432 respectively). Linear models were built to further evaluate the impact of donor ventilation parameters on LMV (table 1). The first model was based on donor P/F ratio, donor age, donor intubation time, donor smoking history, donor pCO2, aspiration, chest trauma and pathologic chest X-ray. This model performed poorly (multiple R-squared=0.063). In a second model, donor ventilation parameters were included and C dyn was identified as the strongest predictor for LMV. The third model was extended by recipient factors, which significantly improved the robustness of the model (multiple R-squared=0.293). In this prospective evaluation of donor lung parameters, currently used donor quality criteria poorly predicted recipient LMV. Our data suggest that C dyn is a strong donor-bound parameter to predict short-term graft performance, however, recipient factors are similarly relevant. [ABSTRACT FROM AUTHOR]