Ann Thorac Surg 2006;82:2002-2003
© 2006 The Society of Thoracic Surgeons
Original Articles: General Thoracic
Invited commentary
David C. McGiffin, MD
Department of Surgery, University of Alabama at Birmingham, 1530 3rd Ave S, LHRB 780, Birmingham, AL 35294-0007
(Email: david.mcgiffin{at}ccc.uab.edu).
The evaluation of donor lungs remains an inexact science. It is known, for example, that there is a lack of correlation between arterial pO2 and pulmonary venous pO2 [1, 2]. For this reason, it is not surprising that some studies [3, 4] have failed to find a consistent relationship between an arterial pO2 less than 300 mm Hg (used as a criterion for a "marginal" donor lung [3]) and primary graft failure, given the effects of contralateral lung edema, consolidation, contusion, or collapse on the arterial pO2.
This study by Botha and colleagues [1] was designed to determine the utility of donor pulmonary vein pO2 in donor lung evaluation and the relationship of this measurement to the incidence of primary graft dysfunction. One of the difficulties implicit in determining the adverse impact of a risk factor (in this case, pulmonary vein pO2) on an event (in this case, primary graft dysfunction) is that there may be insufficient numbers of patients with the risk factor within the boundaries of prudent clinical practice (in this case, donor lung selection) to allow expression of the risk factor’s effect on the outcome event. Nonetheless, Botha and colleagues’ [1] finding of a greater likelihood of primary graft failure in donor lungs with a pulmonary vein pO2 less than 300 mm Hg, although at the threshold of statistical detectability, provides more persuasive information than previous studies that were based on low arterial pO2. From now on, any study of primary graft failure that uses arterial pO2 as a risk factor can not reasonably expect to have the same tractability as a study using differential pulmonary vein pO2 measurements.
Although this study did not specifically address the issue of increasing donor lung availability, it is implicit in the findings and worthy of emphasis. The donor lung procurement rate is still the major obstacle to lung transplantation becoming routinely available for therapy for more patients with end-stage lung disease. In the current climate, favoring bilateral lung transplantation because of the likely greater pulmonary reserve slowing the progression of bronchiolitis obliterans syndrome, we should not lose sight of the significant survival benefit that single lung transplant provides for patients with interstitial lung disease and the improvement in quality of life for patients with emphysema. Differential pulmonary vein pO2 measurement is a simple and reliable way of increasing the rate of single lung procurement.
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References
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- Botha P, Trivedi D, Searl CP, et al. Differential pulmonary vein gases predict primary graft dysfunction Ann Thorac Surg 2006;82:1998-2003.[Abstract/Free Full Text]
- McGiffin DC, Zorn Jr GL, Young Jr KR, et al. The intensive care unit oxygen challenge should not be used for donor lung function decision-making J Heart Lung Transplant 2005;24:1902-1905.[Medline]
- Sundaresan S, Semenkovich J, Ochoa L, et al. Successful outcome of lung transplantation is not compromised by the use of marginal donor lungs J Thorac Cardiovasc Surg 1995;109:1075-1079discussion 1079-80.[Abstract/Free Full Text]
- Lardinois D, Banysch M, Korom S, et al. Extended donor lungs: eleven years experience in a consecutive series Eur J Cardiothorac Surg 2005;27:762-767.[Abstract/Free Full Text]
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