Lungs from polytrauma donors with significant chest trauma can be safely used for transplantation.
Stefan Schwarz, Nina Rahimi, Daria Kifjak, Florian Frommlet, Alberto Benazzo, Peter Jaksch, Walter Klepetko, Konrad Hoetzenecker, Vienna Lung Transplant Group
Author Information
Stefan Schwarz: Division of Thoracic Surgery, Medical University of Vienna, Vienna, Austria.
Nina Rahimi: Division of Thoracic Surgery, Medical University of Vienna, Vienna, Austria.
Daria Kifjak: Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria.
Florian Frommlet: Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria.
Alberto Benazzo: Division of Thoracic Surgery, Medical University of Vienna, Vienna, Austria.
Peter Jaksch: Division of Thoracic Surgery, Medical University of Vienna, Vienna, Austria.
Walter Klepetko: Division of Thoracic Surgery, Medical University of Vienna, Vienna, Austria.
Konrad Hoetzenecker: Division of Thoracic Surgery, Medical University of Vienna, Vienna, Austria. Electronic address: konrad.hoetzenecker@meduniwien.ac.at.
BACKGROUND: The use of organs from polytrauma donors for lung transplantation is controversial in the literature. For many centers, the radiologic manifestation of lung contusions is a clear reason to reject an organ offer. This results in the loss of potentially viable organs for the donor pool. METHODS: We analyzed 1152 donor lungs procured by our transplant center between January 2010 and June 2018. These included 118 lungs with a history of polytrauma involving the chest. Sixteen polytrauma donor lungs were rejected after procurement. A total of 102 lungs were transplanted, divided into 2 groups: the polytrauma contusion group (n = 44), comprising polytrauma donors with radiologic signs of lung contusion at the time of offer, and the polytrauma clear group (n = 58), comprising polytrauma donors without lung contusion. Nontrauma donor lungs transplanted during the study period were assigned to a polytrauma control group (n = 650). Short- and long-term outcomes of the 3 groups were compared. RESULTS: Basic demographic data and preoperative factors were similar in the 3 groups. Rates of primary graft dysfunction grade 3 at 72 hours did not differ among the 3 groups (0.0% vs 3.4% vs 3.9%; P = .409). The duration of ventilation was similar the 3 groups: 45 hours (interquartile range [IQR], 28-94 hours), 37 hours (IQR, 22-71 hours), and 42 hours (IQR, 22-96 hours), respectively (P = .674). Long-term graft survival was not impaired in the trauma groups compared with controls. One-year survival rates were 84.1% for the polytrauma contusion group, 93.1% for the polytrauma clear group, and 83.1% for the no polytrauma group. Five-year graft survival in the 3 groups was 74.7%, 87.2%, and 70.0%, respectively. CONCLUSIONS: Lung transplantation using organs from polytrauma donors is associated with similar short- and long-term results as transplantation from nontrauma donors. The presence or absence of radiologic signs of lung contusion at the time of offer has no impact on primary graft function and long-term survival.
