Donor lung pathology: correlation with outcome of transplanted contralateral lung

To compare clinical results of single lung transplantation with pretransplantation pathology, we reviewed 15 human lungs from 12 donors, which clinically satisfied donor lung criteria but were not transplanted. In nine of these cases the contralateral lung was transplanted. Seven of these nine unused lungs showed mild pathologic changes, including emphysema, focal fibrosis, and old and recent hemorrhage, which had no impact on the outcome of the transplanted contralateral lung. One case had moderate generalized emphysema, which also did not affect the outcome because the other lung was given to a patient with severe emphysema. One donor lung showed severe overinflation artifact, which we think contributed to the early graft failure in a patient with primary pulmonary hypertension. We conclude that, despite satisfying standard donor lung criteria, many lungs have abnormal pathology. This may impact both short- and long-term survival.