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Impact of Donor Arterial Partial Pressure of Oxygen on Outcomes After Lung Transplantation in Adult Cystic Fibrosis Recipients

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Abstract

Introduction

Donor PaO2 levels are used for assessing organs for lung transplantation (LTx), but survival implications of PaO2 levels in adult cystic fibrosis (CF) patients receiving LTx are unclear.

Methods

UNOS registry data spanning 2005–2013 were used to test for associations of donor PaO2 with patient survival and bronchiolitis obliterans syndrome (BOS) in adult (age ≥ 18 years) first-time LTx recipients diagnosed with CF.

Results

The analysis included 1587 patients, of whom 1420 had complete data for multivariable Cox models. No statistically significant differences among donor PaO2 categories of ≤200, 201–300, 301–400, or >400 mmHg were found in univariate survival analysis (log-rank test p = 0.290). BOS onset did not significantly differ across donor PaO2 categories (Chi-square p = 0.480). Multivariable Cox models of patient survival supported the lack of difference across donor PaO2 categories. Interaction analysis found a modest difference in survival between the two top categories of donor PaO2 when examining patients with body mass index (BMI) in the lowest decile (≤16.5 kg/m2).

Conclusions

Donor PaO2 was not associated with survival or BOS onset in adult CF patients undergoing LTx. Notwithstanding statistically significant interactions between donor PaO2 and BMI, there was no evidence of post-LTx survival risk associated with donor PaO2 below conventional thresholds in any subgroup of adults with CF.

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References

  1. Yusen RD, Edwards LB, Kucheryavaya AY et al (2014) The registry of the International Society for Heart and Lung Transplantation: thirty-first adult lung and heart-lung transplant report–2014; focus theme: retransplantation. J Heart Lung Transpl 33(10):1009–1024

    Article  Google Scholar 

  2. Benden C, Goldfarb SB, Edwards LB et al (2014) The registry of the International Society for Heart and Lung Transplantation: seventeenth official pediatric lung and heart-lung transplantation report–2014; focus theme: retransplantation. J Heart Lung Transpl 33(10):1025–1033

    Article  Google Scholar 

  3. Thabut G, Christie JD, Mal H et al (2013) Survival benefit of lung transplant for cystic fibrosis since lung allocation score implementation. Am J Respir Crit Care Med 187(12):1335–1340

    Article  PubMed  Google Scholar 

  4. Kawut SM, Reyentovich A, Wilt JS et al (2005) Outcomes of extended donor lung recipients after lung transplantation. Transplantation 79(3):310–316

    Article  PubMed  Google Scholar 

  5. Yeung JC, Cypel M, Waddell TK et al (2009) Update on donor assessment, resuscitation, and acceptance criteria, including novel techniques–non-heart-beating donor lung retrieval and ex vivo donor lung perfusion. Thorac Surg Clin 19(2):261–274

    Article  PubMed  Google Scholar 

  6. Ingemansson R, Eyjolfsson A, Mared L et al (2009) Clinical transplantation of initially rejected donor lungs after reconditioning ex vivo. Ann Thorac Surg 87(1):255–260

    Article  PubMed  Google Scholar 

  7. Klein AS, Messersmith EE, Ratner LE et al (2010) Organ donation and utilization in the United States, 1999–2008. Am J Transpl 10(4 Pt 2):973–986

    Article  CAS  Google Scholar 

  8. Mason DP, Thuita L, Nowicki ER et al (2010) Should lung transplantation be performed for patients on mechanical respiratory support? The US experience. J Thorac Cardiovasc Surg 139(3):765.el–773.el

    Article  Google Scholar 

  9. Reyes KG, Mason DP, Thuita L et al. (2010) Guidelines for donor lung selection: time for revision? Ann Thorac Surg 89(6):1756–1764; discussion 1764-5

  10. Cypel M, Yeung JC, Liu M et al (2011) Normothermic ex vivo lung perfusion in clinical lung transplantation. N Engl J Med 364(15):1431–1440

    Article  CAS  PubMed  Google Scholar 

  11. Levvey BJ, Harkess M, Hopkins P et al (2012) Excellent clinical outcomes from a national donation-after-determination-of-cardiac-death lung transplant collaborative. Am J Transpl 12(9):2406–2413

    Article  CAS  Google Scholar 

  12. Bernhardt AM, Rahmel A, Reichenspurner H (2013) The unsolved problem of organ allocation in times of organ shortage: the German solution? J Heart Lung Transpl 32(11):1049–1051

    Article  Google Scholar 

  13. Morrissey PE, Monaco AP (2014) Donation after circulatory death: current practices, ongoing challenges, and potential improvements. Transplantation 97(3):258–264

    Article  PubMed  Google Scholar 

  14. Thabut G, Mal H, Cerrina J et al (2005) Influence of donor characteristics on outcome after lung transplantation: a multicenter study. J Heart Lung Transpl 24(9):1347–1353

    Article  Google Scholar 

  15. Frost AE (1997) Donor criteria and evaluation. Clin Chest Med 18(2):231–237

    Article  CAS  PubMed  Google Scholar 

  16. Orens JB, Boehler A, de Perrot M et al (2003) A review of lung transplant donor acceptability criteria. J Heart Lung Transpl 22(11):1183–1200

    Article  Google Scholar 

  17. Zafar F, Khan MS, Heinle JS et al (2012) Does donor arterial partial pressure of oxygen affect outcomes after lung transplantation? A review of more than 12,000 lung transplants. J Thorac Cardiovasc Surg 143(4):919–925

    Article  PubMed  Google Scholar 

  18. Harjula A, Baldwin JC, Starnes VA et al (1987) Proper donor selection for heart-lung transplantation. The Stanford experience. J Thorac Cardiovasc Surg 94(6):874–880

    CAS  PubMed  Google Scholar 

  19. Hennessy SA, Hranjec T, Swenson BR et al (2010) Donor factors are associated with bronchiolitis obliterans syndrome after lung transplantation. Ann Thorac Surg 89(5):1555–1562

    Article  PubMed  PubMed Central  Google Scholar 

  20. United Network for Organ Sharing/Organ Procurement and Transplantation Network Standard Transplant Analysis and Research Database. http://optn.transplant.hrsa.gov/data/about/OPTNDatabase.asp. Accessed 6 Sept 2013

  21. Iribarne A, Russo MJ, Davies RR et al (2009) Despite decreased wait-list times for lung transplantation, lung allocation scores continue to increase. Chest 135(4):923–928

    Article  PubMed  Google Scholar 

  22. Valapour M, Skeans MA, Heubner BM et al (2014) OPTN/SRTR 2012 Annual Data Report: lung. Am J Transpl 14(Suppl 1):139–165

    Article  Google Scholar 

  23. McShane PJ, Garrity ER Jr (2013) Impact of the lung allocation score. Semin Respir Crit Care Med 34(3):275–280

    Article  PubMed  Google Scholar 

  24. Hayes D Jr, Kirkby S, Whitson BA et al (2015) Mortality risk and pulmonary function in adults with cystic fibrosis at time of wait listing for lung transplantation. Ann Thorac Surg 100(2):474–479

    Article  PubMed  Google Scholar 

  25. Hayes D Jr, Daniels CJ, McCoy KS et al (2016) Pulmonary artery pressure and benefit of lung transplantation in adult cystic fibrosis patients. Ann Thorac Surg 101(3):1104–1109

    Article  PubMed  Google Scholar 

  26. Gabbay E, Williams TJ, Griffiths AP et al (1999) Maximizing the utilization of donor organs offered for lung transplantation. Am J Respir Crit Care Med 160(1):265–271

    Article  CAS  PubMed  Google Scholar 

  27. Lardinois D, Banysch M, Korom S et al (2005) Extended donor lungs: eleven years experience in a consecutive series. Eur J Cardiothorac Surg 27(5):762–767

    Article  PubMed  Google Scholar 

  28. Du ZY, Hicks M, Winlaw D, Spratt P, Macdonald P (1996) Ischemic preconditioning enhances donor lung preservation in the rat. J Heart Lung Transpl 15(12):1258–1267

    CAS  Google Scholar 

  29. Friedrich I, Spillner J, Lu EX et al (2001) Ischemic pre-conditioning of 5 minutes but not of 10 minutes improves lung function after warm ischemia in a canine model. J Heart Lung Transpl 20(9):985–995

    Article  CAS  Google Scholar 

  30. Markart P, Schmidt R, Ruppert C et al (2005) Ischemic and endotoxin pre-conditioning reduce lung reperfusion injury-induced surfactant alterations. J Heart Lung Transpl 24(10):1680–1689

    Article  Google Scholar 

  31. Merry HE, Wolf PS, Fitzsullivan E, Keech JC, Mulligan MS (2010) Lipopolysaccharide pre-conditioning is protective in lung ischemia-reperfusion injury. J Heart Lung Transpl 29(4):471–478

    Article  Google Scholar 

  32. Tierney DF (1974) Lung metabolism and biochemistry. Annu Rev Physiol 36:209–231

    Article  CAS  PubMed  Google Scholar 

  33. Touya JJ, Rahimian J, Corbus HF et al (1986) The lung as a metabolic organ. Semin Nucl Med 16(4):296–305

    Article  CAS  PubMed  Google Scholar 

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Author Contributions

Don Hayes, Jr.: Conception and design, acquisition of data, interpretation of data, drafted the manuscript; Benjamin T. Kopp, Stephen E. Kirkby, Susan D. Reynolds, Heidi M. Mansour, Joseph D. Tobias: Interpretation of data, revision of the manuscript; Dmitry Tumin: Conception and design, interpretation of data, statistical analysis, revision of the manuscript.

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Authors and Affiliations

  1. Departments of Pediatrics, Nationwide Children’s Hospital, The Ohio State University College of Medicine, 700 Children’s Drive, Columbus, OH, 43205, USA

    Don Hayes Jr., Benjamin T. Kopp, Stephen E. Kirkby, Susan D. Reynolds & Dmitry Tumin

  2. Departments of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA

    Don Hayes Jr. & Stephen E. Kirkby

  3. Departments of Surgery, The Ohio State University College of Medicine, Columbus, OH, USA

    Don Hayes Jr.

  4. Departments of Anesthesiology, The Ohio State University College of Medicine, Columbus, OH, USA

    Joseph D. Tobias

  5. Center for Epidemiology of Organ Failure and Transplantation, Nationwide Children’s Hospital, Columbus, OH, USA

    Don Hayes Jr., Benjamin T. Kopp, Stephen E. Kirkby, Joseph D. Tobias & Dmitry Tumin

  6. Section of Pulmonary Medicine, Nationwide Children’s Hospital, Columbus, OH, USA

    Don Hayes Jr., Benjamin T. Kopp & Stephen E. Kirkby

  7. Center for Perinatal Research, Nationwide Children’s Hospital, Columbus, OH, USA

    Susan D. Reynolds

  8. Department of Anesthesiology and Pain Medicine, Nationwide Children’s Hospital, Columbus, OH, USA

    Joseph D. Tobias & Dmitry Tumin

  9. The University of Arizona-Tucson College of Pharmacy and College of Medicine, Tucson, AZ, USA

    Heidi M. Mansour

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  1. Don Hayes Jr.
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Correspondence to Don Hayes Jr..

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Hayes, D., Kopp, B.T., Kirkby, S.E. et al. Impact of Donor Arterial Partial Pressure of Oxygen on Outcomes After Lung Transplantation in Adult Cystic Fibrosis Recipients. Lung 194, 547–553 (2016). https://doi.org/10.1007/s00408-016-9902-3

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  • DOI: https://doi.org/10.1007/s00408-016-9902-3

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