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Ann Thorac Surg 2010;89:1555-1562. doi:10.1016/j.athoracsur.2010.01.060
© 2010 The Society of Thoracic Surgeons
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Benjamin D. Kozower
David R. Jones
Gorav Ailawadi
Irving L. Kron
Christine L. Lau
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Right arrow Lung - transplantation

Original Articles: General Thoracic

Donor Factors Are Associated With Bronchiolitis Obliterans Syndrome After Lung Transplantation

Sara A. Hennessy, MD, Tjasa Hranjec, MD, MS, Brian R. Swenson, MD, MS, Benjamin D. Kozower, MD, MPH, David R. Jones, MD, Gorav Ailawadi, MD, Irving L. Kron, MD, Christine L. Lau, MD*

Department of Surgery, University of Virginia, Charlottesville, Virginia

Accepted for publication January 25, 2010.

* Address correspondence to Dr Lau, University of Virginia Health System, Division of Thoracic and Cardiovascular Surgery, PO Box 800679, Charlottesville, VA 22908-0679 (Email: cll2y{at}virginia.edu).

Presented at the Fifty-sixth Annual Meeting of the Southern Thoracic Surgical Association, Marco Island, FL, Nov 4–7, 2009.

Background: Bronchiolitis obliterans syndrome (BOS) is the major hurdle preventing long-term success in lung transplantation, and is the primary reason for the 50% 5-year survival. Recipient and perioperative risk factors have been investigated in BOS, but less is known about donor factors. Therefore, we investigated what donor factors are important in the development of BOS.

Methods: We performed a retrospective review of the United Network for Organ Sharing lung transplant database from 1987 to 2008. Lung transplant recipients had yearly follow-up. Donor factors were evaluated for their influence on BOS development. Kaplan-Meier plots of BOS-free survival were compared for each donor factor and a multivariate Cox proportional hazard model for BOS was created with donor factors.

Results: A total of 17,222 lung transplant recipients were identified; 6,991 recipients had sufficient follow-up BOS data. Of these recipients 57% (n = 3,984) developed BOS within 5 years. Recipients who received lungs from donors who were younger, without an active pulmonary infection, or those without current tobacco use had longer BOS-free survival. Recipients who received lungs with higher partial pressures of oxygen in arterial blood (PaO 2) developed more BOS (p < 0.0001). Donor high PaO 2, older age, and current tobacco use were independent predictors of BOS in lung transplant recipients.

Conclusions: Donor factors and donor management strategies are important contributors to development of recipient BOS. Identification of these factors may help limit BOS and may identify recipients at high risk. Surprisingly, high PaO 2 in the donor is an independent predictor of BOS development.




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