Longer Duration of Donor Ventilation is not Associated With Long-term Lung Function After Lung Transplantation

Prolonged mechanical ventilation increases the risk of developing ventilator-induced lung injury, but the relationship between the duration of donor ventilation (DDV) and post-lung transplant lung function is unknown.

We analyzed adult patients undergoing double lung transplantation in our program between January 2007 and December 2020. The risk factor of interest was DDV in days before organ retrieval. The primary outcome was forced expiratory volume in 1 s % predicted at 1-y posttransplant (1yFEV1%), and secondary outcomes, including lung function at 3 mo, short and long-term graft dysfunction, and mortality, were tested. We used multivariable linear regression to test the association between DDV and 1yFEV1%, adjusting for variables known to be associated with posttransplant lung function.

Seven hundred fourteen patients were eligible for the study, 588 of whom had available DDV data. Median DDV was 3 d (range, 0-37 d). In the multivariable analysis, longer DDV was not associated with a lower 1yFEV1% ( P  = 0.897) or other secondary adverse outcomes. DDV was however significantly associated with donor bronchoalveolar lavage culture positivity for clinically relevant organisms (odds ratio, 1.11 per day of ventilation; 95% confidence interval, 1.02-1.21; P  = 0.02).

DDV before procurement was not associated with 1yFEV1% or other secondary adverse outcomes. This may relate to a lower risk of ventilator-induced lung injury and its long-term effects in acceptable lungs that otherwise meet criteria for donation. This suggests acceptable donors with extended ventilation duration before offer can be safely considered for lung transplantation.