Hanging donor lungs give good short‐, mid‐ and long‐term results in lung transplantation

Abstract

Background:Hanging donors are considered as marginal donors and frequently unsuitable for lung transplantation. However, there is no evidence of higher lung transplantation (LTx) morbidity-mortality with lungs providing by hanging donor. Methods:Between January 2010 and July 2015, we performed a retrospective study at Foch hospital. We aimed to assess whether hanging donor grafts are suitable for lung transplantation. Results: A total of 299 LTx were performed. Subjects were allocated to a hanging group (HG) (n = 20) and a control group (CG) (n = 279). Donor and recipient characteristics did not differ. Primary graft dysfunction (PGD) at 72 hours was comparable in both groups (P = .75). The median duration of postoperative mechanical ventilation (1 [range, 0-84] vs 1 [range, 0-410] day, P = .35), the hospital length of stay (31 days [20-84] vs 32 days [12-435], P = .36) did not differ between the two groups. No statistically significant difference was found in 1-year and 5-year survival between the HG (83% and 78%) and the CG (86% and 75%), P = .85. Conclusion: We believe that hanging donors should be considered as conventional donors with particular caution in the final evaluation of the graft and in perioperative management. K E Y W O R D S extended donors, hanging donors, lung transplantation, marginal donors, primary graft dysfunction R E FE R E N C E S

A narrative review of the impact of donor factors and selection criteria on outcomes after lung transplantation

“…While outcomes from donors with severe asthma have been poor (39), a number of more recent reports suggest that donors with other causes of acute airway obstruction can be transplanted. Death from hanging and other causes of acute airway obstruction are thought to cause post-obstructive barotrauma and negative pressure pulmonary edema that historically made these donors poor candidates for transplantation (40). Several studies, however, demonstrated that in otherwise suitable donors, outcomes from these donors are no different than from conventional donors (40,41).…”

“…Death from hanging and other causes of acute airway obstruction are thought to cause post-obstructive barotrauma and negative pressure pulmonary edema that historically made these donors poor candidates for transplantation (40). Several studies, however, demonstrated that in otherwise suitable donors, outcomes from these donors are no different than from conventional donors (40,41). In both studies, these donors represented nearly 10% of all transplants performed at these centers, suggesting wider utilization these donors could have a significant impact on transplant volumes.…”

Donor quality assessment and size match in lung transplantation

“…Lung allografts from hanging donors are historically considered marginal. It is believed that post-obstructive barotrauma and injury to alveolar-capillary barrier increases capillary permeability [ 23 , 24 ]. Moreover, when the compression is suddenly removed, a prompt variation in venous return and intrathoracic pressure leads to reperfusion pulmonary edema with hyperemia [ 23 , 24 ].…”

“…It is believed that post-obstructive barotrauma and injury to alveolar-capillary barrier increases capillary permeability [ 23 , 24 ]. Moreover, when the compression is suddenly removed, a prompt variation in venous return and intrathoracic pressure leads to reperfusion pulmonary edema with hyperemia [ 23 , 24 ]. Bennett et al suggested that hanging donors may have higher pulmonary vascular resistance and higher peak airway pressure (PAP) [ 25 ].…”

“…Bennett et al suggested that hanging donors may have higher pulmonary vascular resistance and higher peak airway pressure (PAP) [25]. Most centers are very conservative when selecting these types of donors [24,25]. However, contrary to common belief, allografts from hanging donors may be usable [25] and no statistically significant difference is reported at least in short-term and mid-term survival between hanging donor versus conventional donors [24,[26][27][28].…”