Effect of Duration of Donor Ventilation on Lung Transplant Outcomes

Abstract

Background: Duration of donor ventilation (DDV) often impacts willingness to accept lungs for transplantation. We investigated the association of DDV with adverse lung transplant outcomes.

Methods: The United Network for Organ Sharing Stand Transplant Analysis and Research database was retrospectively reviewed. DDV was defined in days from date of donor intubation to date of donation. Incomplete or extreme data (DDV >30 days), donation after circulatory death donors, and donors for multiorgan, redo, and pediatric recipients were excluded. Recipients were stratified using a common clinical cutoff of DDV ≤7 days and DDV >7 days. Propensity score matching was performed 3:1 using donor, recipient, and center variables. Outcomes were primary graft dysfunction at 72 hours, 90-day graft survival, and 1-, 3-, and 5-year recipient survival.

Results: From May 8, 2006, to June 28, 2023, 7856 lung transplants were performed with available data. Propensity score matching yielded 2835 lung transplants between the short DDV (n = 2103) and long DDV groups (n = 732). Rates of primary graft dysfunction (17.7% vs 19.8%, P = .466), 90-day graft survival (94% vs 97%, P = .936), and recipient survival at 1 year (89% vs 90%), 3 years (73% vs 74%) and 5 years (58% vs 55%) were not significantly different (P = .915) between groups. The adjusted plot of DDV showed no significant association with the hazard ratio for graft failure.

Conclusions: DDV is not associated with adverse recipient outcomes when stratified by a 7-day cutoff. Additionally, no specific time point for DDV was identified to significantly increase the hazard for graft failure. DDV should not be an isolated factor in denial of lungs for transplantation.