Highlights:
- Lung recovery by a hospital-based donor care unit extended survival by 117 days.
- Lung recovery in an independent donor care unit versus a hospital-based donor care unit was associated with an increased adjusted risk of graft failure.
Lung transplant patients who received lungs from donors cared for in a hospital-based donor care unit survived longer than those who received lungs from donors cared for in a free-standing donor care unit, a study has found. JAMA Network Open.
“Clinicians should be aware that the management of deceased organ donors is changing in the United States, with the concentration of donors in donor care units potentially impacting transplant and survival outcomes for patients with end-stage pulmonary and other organ disease.” Emily A. VailDoctor of Medicine, Master of Science, “These findings suggest that the use of serotonin in patients with pulmonary circulation may be indicative of a potential risk of developing pulmonary embolism,” said Dr.
In a retrospective cohort study, Beil and his colleagues evaluated 5,149 deceased lung donors and 1,657 transplant recipients (mean age 58.6 years, 64.4% male) whose organs were retrieved between April 2017 and June 2022, and examined differences in survival rates between people who received lungs from donors cared for in independent units and those cared for in hospital-based units.
Within the donor cohort, more donors underwent organ retrieval in freestanding donor care units than in hospital-based donor care units (71.5% vs. 28.4%).
The researchers observed that the proportion of lung donations from independent donor care units was significantly higher than from hospital-based units (33.5%; n = 1,233 vs. 28.5%; n = 418; P < .001), and similarly, more people in the study's recipient cohort received lung transplants from independent donor care units (74.5%; n = 1,250 vs. 24.6%; n = 407).
Among the 1,651 donors who donated at least one lung for transplantation, there were significant differences between donors in hospital-based donor care units and those in independent care units based on race (white, 51.7% vs. 65.2%), ethnicity (Hispanic, 22.2% vs. 13.1%), and pulmonary infection (77.8% vs. 68%).
Turning to transplant patients, the researchers also observed several important differences between patients who received lungs from hospital-based donor care units and those who received lungs from independent donor care units, including:
- Race (White, 67.1% vs. 76.1%; Asian, 5.7% vs. 2.6%)
- Ethnicity (Hispanic, 15.2% vs. 11.8%)
- COPD (21.6% vs. 27.1%)
- Restrictive lung disease (71% vs. 62.3%)
- Pre-transplant 6-minute walk distance (median, 668 feet vs. 767 feet)
- Lung allocation score at transplant eligibility (median, 39 vs. 37.9).
Over a mean posttransplant follow-up period of 734 days, lung transplant recipients from independent donor care units were significantly more likely to experience graft failure (defined as death or retransplantation) compared with transplant recipients from hospital-based donor care units (30.2% vs. 22.9%). P = .005).
Those who received lungs from independent donor care units had a median survival of 1,548 days, compared with 1,665 days for those who received donor lungs from hospital-based units, a 117-day increase (P = .04).
“We hypothesized that we would not find differences because donor management is similar across types of donor care units and we expected that many factors other than the donor influence lung transplant recipient survival. [so] “We were surprised to find that recipients survived longer in patients whose donors were managed in hospital-affiliated units,” Bales says.
The researchers further found that in a Cox proportional hazards model adjusting for several donor and recipient variables associated with recipient survival, lung recovery in an independent donor care unit was associated with a higher risk of graft failure (adjusted HR = 1.85; 95% CI, 1.28-2.65) compared with lung recovery in a hospital-based donor care unit.
“This study builds on previous research comparing short-term organ donation outcomes (such as number and type of organs transplanted) between adult deceased organ donors managed in donor care units after brain death and traditional hospitals,” Vail said. “The findings do not apply to deceased infant or child donors, deceased organ donors after circulatory death, or living organ donors who are cared for in hospitals and are rarely transferred to donor care units.”
Going forward, Bales told Helio, research should focus on how to improve outcomes for donors and recipients.
“Future studies will explore which factors vary across types of donor care units (such as donor selection and clinical donor management) to determine whether changing these practices could improve donor outcomes in all settings,” she said.
