Lung transplantation from polytrauma donors: beyond primary graft dysfunction

Area of Science:

• Transplantation immunology
• Thoracic surgery
• Organ donation

Background:

• Lung donor pool faces challenges with increasing age and marginal graft quality.
• Polytrauma donors (PD) offer younger organs but raise concerns about trauma-related lung injury.
• Evaluating lung graft quality from PDs is crucial for expanding donor options.

Purpose of the Study:

• To compare early and mid-term outcomes of lung transplantation using grafts from polytrauma donors (PD) versus non-polytrauma donors (NPD).
• To assess the safety and efficacy of utilizing PD lungs to address donor shortages.
• To determine if PD grafts impact primary graft dysfunction (PGD) and long-term pulmonary function.

Main Methods:

• Retrospective analysis of 125 lung transplant recipients between January 2013 and June 2024.
• Comparison of perioperative outcomes, PGD, and pulmonary function between PD (n=36) and NPD (n=89) groups.
• Propensity score matching (PSM) was used to control for baseline differences in donor and recipient characteristics.

Main Results:

• PDs were younger and more frequently male, with higher rates of pulmonary contusions.
• Early outcomes, including PGD and ICU stay, were similar between PD and NPD groups.
• After PSM, no significant differences in survival, perioperative outcomes, or pulmonary function were observed at 6 months.

Conclusions:

• Lung transplantation with PD grafts is not associated with worse perioperative or mid-term outcomes.
• Outcomes after lung transplantation from PDs are comparable to NPDs after adjusting for baseline differences.
• Selective use of PD grafts is a safe strategy to expand the donor pool for lung transplantation.