Single-lung transplantation can be performed with acceptable outcomes using selected donors with heavy smoking history

13Citations
Citations of this article
12Readers
Mendeley users who have this article in their library.

Abstract

Background We attempt to determine if adult, single-lung transplantation could be performed with acceptable results in heavy-smoking donors (HSDs; > 20 pack-years). Methods The United Network of Organ Sharing database was examined for adult single-lung transplantation from 2005 to 2011. Results Of the 3,704 single-lung transplantations, 498 (13.4%) were from HSDs. The 2 groups were similar in recipient age (60.6 vs 60.7 years, p = 0.20), male gender (61.3% vs 59.8%, p = 0.54), ischemic time (4.1 vs 4.2 hours, p = 0.11), and pre-transplant forced expiratory volume in 1 second (FEV1; 41.1% vs 40.0% predicted). Recipients of HSDs had lower lung allocation score (39.7 vs 38.0, p = 0.02), less human leukocyte antigen mismatches (4.6 vs 4.5, p = 0.01), and higher class I panel reactive antibody (2.9% vs 3.8%, p < 0.001). HSDs were older (33.0 vs 41.3 years, p < 0.001) and less likely male (62.5 vs 56.0%, p = 0.01). Recipients with HSDs had longer length of stay (20.5 vs 23.0 days, p < 0.001) and lower peak FEV1 after single-lung transplantation (80.1% vs 73.4%, p < 0.001). Freedom from bronchiolitis obliterans syndrome (p = 0.64), post-single-lung transplantation decrement in FEV1 (p = 0.07), and median survival (1,516 vs 1,488 days, p = 0.10) were similar. Multivariable analysis found receiving lungs from actively smoking HSDs was associated with mortality (hazard ratio [HR], 1.23, 95% confidence interval [CI], 1.05-1.45; p = 0.01). Use of HSDs who were not actively smoking was not associated with mortality (HR, 0.84; 95% CI, 0.59-1.19; p = 0.33). Mortality was associated with recipient age, longer ischemic time, race mismatch, class I panel reactive antibody > 10%, mechanical ventilation, and extracorporeal membrane oxygenation as a bridge to transplantation. Conclusions Although single-lung transplantation with actively smoking HSDs results in worse results, outcomes are acceptable and should continue to be considered. © 2013 International Society for Heart and Lung Transplantation.

Cite

CITATION STYLE

APA

Taghavi, S., Jayarajan, S. N., Komaroff, E., Horai, T., Brann, S., Patel, N., … Toyoda, Y. (2013). Single-lung transplantation can be performed with acceptable outcomes using selected donors with heavy smoking history. Journal of Heart and Lung Transplantation, 32(10), 1005–1012. https://doi.org/10.1016/j.healun.2013.05.018

Register to see more suggestions

Mendeley helps you to discover research relevant for your work.

Already have an account?

Save time finding and organizing research with Mendeley

Sign up for free