Louisa Yunzhu Bai, Yan Yan, Charles R Liu, Zhizhou Yang, Anjana Delhi, Su-Hsin Chang, Khashayar Farahnak, Karan Joseph, Christy Hamilton, Brendan T Heiden, Chad A Witt, Rodrigo Vazquez Guillamet, Derek E Byers, Gary F Marklin, Bruce Nicely, Michael Harmon, Matthew G Hartwig, Ruben G Nava, G Alexander Patterson, Bryan F Meyers, Benjamin D Kozower, Daniel Kreisel, Varun Puri
Low initial PaO2 does not preclude donor lung procurement for transplantation with appropriate donor management. Donor lungs with high initial PaO2 can deteriorate and may not be procured. Interventions targeted at increasing donor oxygenation may improve lung procurement in brain-dead donors without compromising recipient survival.
BACKGROUND: There is a persistent shortage of donor lungs for transplantation. The relationship between donor PaO2 trajectory and lung procurement rate is poorly understood.
METHODS: Demographic and clinical data were abstracted from 4854 brain-dead donors from three US organ procurement organizations between 1/2014 and 6/2020 and from their corresponding lung recipients, if applicable. Donors were first stratified into High versus Low initial PaO2 then by final PaO2, using 300 mmHg as the cutoff. Lung procurement rates and corresponding recipient survival between donor groups were studied using multivariable regression and Cox proportional hazard models, respectively.
RESULTS: Over 75% of donors had Low initial PaO2 (3702/4854). Overall lung procurement rate (LPR, lung donors/all donors) was 32.4% (1574/4854). LPR was greater in the High initial group (40.0% versus 30.1%, p<0.001). In the Low initial group, 1380 (37.3%) donors had High final PaO2, with LPR of 67.9%; frequent bronchoscopy, inotropes, and antibiotics were associated with lung procurement in this group. In the High initial group, 615 (53.4%) donors declined to Low final PaO2; shorter lengths of stay were associated with lung procurement in this group. Among recipients of High final PaO2 donor lungs, overall survival was similar regardless of the initial donor PaO2 (aHR 0.96 [95% CI 0.80-1.15]).
CONCLUSIONS: Low initial PaO2 does not preclude donor lung procurement for transplantation with appropriate donor management. Donor lungs with high initial PaO2 can deteriorate and may not be procured. Interventions targeted at increasing donor oxygenation may improve lung procurement in brain-dead donors without compromising recipient survival.