Outcome of Lung Transplantation Using Organ Donors with Evidence of Aspiration

Purpose Aspiration is commonly reported in multiorgan donors. According to standard quality criteria, it is seen as a contraindication for lung utilization. However, an increasing number of transplant centers would accept donor lungs with a history of aspiration as long as lung parenchyma quality is not impaired. Data on the short and long-term outcomes of using this group of donor organs is sparse. Methods We analysed 749 patients who received double lung transplantation between January 2010 and June 2018 in our institution. A total of 30 patients were transplanted using donors with conclusive evidence of significant aspiration. Lungs were accepted for transplantation if P/F ratio was above 250mmHg in absence of significant parenchymal consolidations. The remaining 719 patients were used as control group. Short- and long-term outcomes were compared. Results Basic demographic parameters of recipients were comparable. Donors in aspiration group were significantly younger (34±18 years vs 40±16 years, p=0.034) and had a higher rate of peripheral secretions in bronchoscopy (57.1% vs 25.6%, p=0.02) compared to the control group. Other basic donor parameters did not show statistical differences. Posttransplant results were comparable in both groups. Length of mechanical ventilation was similar with a median of 48h (IQR 128) vs 45h (IQR 73) (p=0.748). There was no significant difference of PGD rates across all time points (T0: p=0.419, T24: p=0.289, T48: p=0.774, T72: p=0.939), ICU stay (16 vs 17 d, p=0.917) as well as total length of stay (35 vs 33 d, p=0.687). While long-term graft survival showed a trend towards impaired results for donor lungs with aspiration, this effect did not reach statistical significance. (1 year: 80.0% vs 85.7%, 5 years: 64.5% vs 75.0%, Log Rank: p=0.123). Conclusion Lung transplantation of donor organs with evidence of aspiration can result in excellent early graft function and comparable long-term outcome in the absence of parenchymal changes. Therefore, careful evaluation of these donors is merited.