Despite Growing Utilization, the Use of Public Health Service Increased Risk Donors for Lung Transplantation is Not Associated with Increased Mortality

Purpose Despite a donor shortage, transplantation of lungs from donors identified as Public Health Service (PHS) Increased Risk Donors (IRDs) remains controversial, representing a potential bridge to this supply gap. While these donors are seronegative for HIV , Hepatitis B, and Hepatitis C, they have factors that place them at increased risk. Prior work has shown that the use of IRDs for lung transplantation does not result in worse survival; however, an updated definition of IRD from the PHS in 2013 has led to greater percentages of IRD classification. Methods The UNOS Standard Transplant Analysis and Research database was queried for adult lung transplantations performed between June 2013 through March 2017. Kaplan-Meier analysis compared survival of recipients receiving IRD lungs versus non-IRD lungs. A multivariate logistic regression model was then constructed to control for donor and recipient factors significant on univariate analysis . Results In the examined period, 7254 lung transplantations were performed, 1471 (20.3%) of which were from IRD, a more than two-fold increase from the years prior to the definition change (Table). IRD and non-IRD cohorts differed significantly in terms of donor age, gender, race, and cause of death, as well as recipient gender and diagnosis. Unadjusted 1-year and 3-year survival was 87.6% and 67.8% for the IRD cohort vs. 88.5% and 70.1% for the non-IRD cohort (Figure, log-rank p=0.0268). When controlling for other donor and recipient factors, IRD status was not an independent predictor of mortality (OR 1.055, 95% CI 0.91-1.22; p=0.47). Conclusion Since 2013, the relative percentage of IRD has increased dramatically, relating to the inclusion of Hepatitis C in the definition. Despite several important differences between cohorts, IRD status itself does not confer a mortality disadvantage and in the era of treatability and cure in most instances for Hepatitis C, the practice of avoiding these donors is outdated.