Eastern Cardiothoracic Surgical Society

Single Lung Transplantation with ABO Compatible Donors Results in Excellent Outcomes
Sharven Taghavi1, Senthil Jayarajan1, Eugene Komaroff , Akira Shiose1, Eros Leotta1, Kazuhiro Hisamoto1, Namrata Patel1, Francis Cordova1, Gerard Criner1, T. Sloane Guy1, Yoshiya Toyoda1, 1Temple University Hospital, Philadelphia, PA, Temple University Department of Public Health, Philadelphia, PA

OBJECTIVE: The goal of this study was to determine if carefully selected ABO compatible donors (ACD) in single lung transplantation (SLT) results in acceptable outcomes.

METHODS: The United Network for Organ Sharing (UNOS) database was reviewed for adult SLT from May 2005 to December 2011. Recipients of ACD were compared to those of ABO identical donors. Risk-adjusted multivariable Cox proportional hazards regression using significant univariate predictors examined mortality.

RESULTS: Of 3,572 SLT, 342 (9.6%) were from ACD. The two groups were evenly matched with regards to recipient age (60.8 vs. 60.2 years, p=0.28), recipient male gender (61.8 vs. 58.2%, p=0.10), lung allocation score (43.4 vs. 42.6, p=0.32), FEV1 (41.2 vs. 40.8%, p=0.32), ischemic time (4.2 vs. 4.0 hours, p=0.09), donor age (34.4 vs. 32.9, p=0.07), and donor male gender (61.5 vs. 65.5, p=0.14). ACD were less likely to be race mismatched (58.3 vs. 50.9%, p=0.01). Median survival was not different (figure). On multivariate analysis, ACD were not associated with mortality (HR: 1.02, 95%CI: 0.85-1.22, p=0.86). Prolonged ischemic time, increasing recipient creatinine, increasing recipient age, race mismatch, class I plasma reactive antigen panel >10%, and the use of mechanical ventilation or extracorporeal membrane oxygenation were associated with mortality (table). Peak post-transplant FEV1 (64.5 vs. 64.0%, p=0.69), and decrement in FEV1 over time were similar (p=0.82). Freedom from BOS was longer in the ACD group (1,146 vs. 1,424 days, p=0.01).

CONCLUSIONS: This multi-institutional analysis is the largest to study ACD in SLT and demonstrates that carefully selected ACD results in excellent outcomes.

Cox Proportional Hazards Regression Analysis Showing Variables Associated with Mortality

Hazard Ratio 95%
Confidence
Interval
p-Value
Ischemic Time 8-10 hours (Reference 6 hours) 2.02 1.11-3.67 0.02
Recipient Creatinine (per mg/dL) 1.25 1.09-1.43 0.002
Recipient Age (per year) 1.01 1.00-1.02 0.02
Race Mismatch 1.20 1.07-1.35 0.002
Class I Plasma Reactive Antigen Panel >10% 1.31 1.12-1.52 0.002
Mechanical Ventilation prior to Transplantation 2.58 2.02-3.30 <0.001
Extracorporeal Membrane Oxygenation prior to Transplantation 5.35 3.33-8.60 <0.001