Are lung transplant outcomes related to how often the donor lung was refused?

A recent study has concluded that there is no relationship between lung transplant survival and the number of refusals due to donor quality.

Over 70% of lung transplants are performed with lungs refused by at least one center – indeed some lungs are refused four, five or more times. A recent study utilized the UNOS database to investigate to what extent the number (sequence) of refusals due to donor quality influenced post-transplant outcomes (Singh E et al , 2019)(7).

Over 10,000 transplants were categorized into two groups: those utilizing lungs refused up to three times (low) versus those utilizing lungs refused more than thee times (high). The mean number of refusals was four times.

Perhaps surprisingly, post-transplant one-year survival was similar for both the low and high refusal groups (p = 0.49). Furthermore, groups of recipients who received donors with an increasing number of refusals (>3, >6, or >10) also had similar post-transplant one-year survival (p = 0.77). Treatment for rejection within one year and intubation at 72 hours post-transplant were higher in the high refusal group (p < 0.01). The authors conclude that “lung transplant survival is not associated with number of refusals due to donor quality.” This observation underlines that we are yet to identify reliable markers of donor lung quality.


7. Singh E, et al, Sequence of refusals for donor quality, organ utilization, and survival after lung transplantation J Heart Lung Transplant. 2019 Jan;38(1):35-42. doi: 10.1016/j.healun.2018.08.009. Epub 2018 Aug 17. (link to abstract)

Xvivo Insights PB-2019-02-04