Extended criteria donor lungs do not impact recipient outcomes in pediatric transplantation.

Sommer W¹, Ius F², Müller C³, Bobylev D², Kuehn C¹, Avsar M², Salman J³, Siemeni T², Miha O J⁴, Horke A², Haverich A¹, Tudorache I², Schwerk N³, Warnecke G⁵. ( warnecke.gregor@mh-hannover.de

J Heart Lung Transplant.   2019 May;38(5):560-569. doi: 10.1016/j.healun.2019.02.012. Epub 2019 Feb 27.          

BACKGROUND:

Pediatric lung transplantation remains the only curative treatment option for some end-stage lung diseases in childhood. Recipient numbers outnumber potential donor organs, and therefore a broader group of donor organs must be considered for pediatric lung transplantation. Herein we describe the outcome of utilizing extended criteria donor organs in pediatric lung transplantation.

METHODS:

A retrospective analysis was performed on all pediatric lung transplantations performed at the Hannover Medical School between April 2010 and December 2016. Donors were assigned to a group fulfilling standard donor criteria (International Society for Heart and Lung Transplantation [ISHLT] 2003) or not. Recipients’ early- and mid-term morbidity and mortality were recorded.

RESULTS:

A total of 57 pediatric lung transplantations were performed: 27 donors fulfilled standard donor criteria (standard criteria donor [SCD] group) and 30 donors were extended criteria donors not fulfilling standard donor criteria (extended criteria donor [ECD] group). Pre-operative recipient characteristics, including age  (median [IQR]: 14 [10‒15] vs 13 [10.8‒15] years, p = 0.71), underlying disease, admission to intensive care unit (37.0% vs 50%, p = 0.42), mechanical ventilation  (14.8% vs 10.0%, p = 0.70), and extracorporeal membrane oxygenation (ECMO) support (11.1% vs 23.3%, p = 0.30) of both groups were similar. In the ECD group, more atypical volume reductions of the allograft were performed (0% vs 16.7%, p = 0.05), yet incidence of post-operative ECMO support was similar for the  2 groups. ECD recipients spent significantly less time on mechanical ventilation (median [IQR]: 2 [1‒2] vs 1 [1‒2] days, p = 0.04)] after surgery, but total intensive  care unit stay and total hospital stay were similar between groups. Pulmonary function testing results at discharge from initial hospital stay, after 1 year, and at last assessment were also similar. Freedom from chronic lung allograft dysfunction at 1 and 5years after transplantation showed no significant differences between groups. Survival rates up to 5years (67.9% vs 90.5%, p = 0.35) after transplantation were comparable between groups, yet, counterintuitively, long-term survival in the ECD group showed superior trends compared with the SCD group.

CONCLUSIONS:

ECD lungs can be used safely for pediatric lung transplantation without compromising short- and mid-term results.

Copyright © 2019 International Society for Heart and Lung Transplantation.
Published by Elsevier Inc. All rights reserved.  KEYWORDS:   donor selection; extended criteria donor lungs; marginal donor lungs; non-standard donor criteria; pediatric lung transplantation; standard donor criteria
PMID:  30852096 DOI: 10.1016/j.healun.2019.02.012