Science and Research

Extended criteria donor lungs do not impact recipient outcomes in pediatric transplantation

BACKGROUND: Pediatric lung transplantation remains the only curative treatment option for some end-stage lung diseases in childhood. Recipient numbers outnumber potential donor organs, and therefore a broader group of donor organs must be considered for pediatric lung transplantation. Herein we describe the outcome of utilizing extended criteria donor organs in pediatric lung transplantation. METHODS: A retrospective analysis was performed on all pediatric lung transplantations performed at the Hannover Medical School between April 2010 and December 2016. Donors were assigned to a group fulfilling standard donor criteria (International Society for Heart and Lung Transplantation [ISHLT] 2003) or not. Recipients' early- and mid-term morbidity and mortality were recorded. RESULTS: A total of 57 pediatric lung transplantations were performed: 27 donors fulfilled standard donor criteria (standard criteria donor [SCD] group) and 30 donors were extended criteria donors not fulfilling standard donor criteria (extended criteria donor [ECD] group). Pre-operative recipient characteristics, including age (median [IQR]: 14 [1015] vs 13 [10.815] years, p=0.71), underlying disease, admission to intensive care unit (37.0% vs 50%, p=0.42), mechanical ventilation (14.8% vs 10.0%, p=0.70), and extracorporeal membrane oxygenation (ECMO) support (11.1% vs 23.3%, p=0.30) of both groups were similar. In the ECD group, more atypical volume reductions of the allograft were performed (0% vs 16.7%, p=0.05), yet incidence of post-operative ECMO support was similar for the 2 groups. ECD recipients spent significantly less time on mechanical ventilation (median [IQR]: 2 [12] vs 1 [12] days, p=0.04)] after surgery, but total intensive care unit stay and total hospital stay were similar between groups. Pulmonaryfunction testing results at discharge from initial hospital stay, after 1 year, and at last assessment were also similar. Freedom from chronic lung allograft dysfunction at 1 and 5years after transplantation showed no significant differences between groups. Survival rates up to 5years (67.9% vs 90.5%, p=0.35) after transplantation were comparable between groups, yet, counterintuitively, long-term survival in the ECD group showed superior trends compared with the SCD group. CONCLUSIONS: ECD lungs can be used safely for pediatric lung transplantation without compromising short- and mid-term results.

  • Sommer, W.
  • Ius, F.
  • Muller, C.
  • Bobylev, D.
  • Kuehn, C.
  • Avsar, M.
  • Salman, J.
  • Siemeni, T.
  • Miha, O. J.
  • Horke, A.
  • Haverich, A.
  • Tudorache, I.
  • Schwerk, N.
  • Warnecke, G.

Keywords

  • donor selection
  • extended criteria donor lungs
  • marginal donor lungs
  • non-standard donor criteria
  • pediatric lung transplantation
  • standard donor criteria
Publication details
DOI: 10.1016/j.healun.2019.02.012
Journal: The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation
Pages: 560-569 
Number: 5
Work Type: Original
Location: BREATH
Disease Area: ROR
Partner / Member: MHH
Access-Number: 30852096
See publication on PubMed

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