Nonstandard Donor Organs in Pediatric Lung Transplantation have no Negative Impact on Recipients Outcome

 

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Background: Pediatric lung transplantation remains the only curative treatment option for end-stage lung diseases in childhood. Recipients outnumber available pediatric donor organs, hence non-ideal donors are considered. Here, we describe the outcome of utilizing non-standard donor organs in pediatric lung transplantation.

Methods: A retrospective analysis of all pediatric lung transplantations (recipient age < 18 years) performed in our center between 04/2010 and 12/2016 was performed. Donors were assigned to a group fulfilling ISHLT Standard Donor Criteria (SDG; Age < 55 years; clear chest X-Ray; PaO2/FiO2 >300; < 20 years Nicotine abuse; absence of chest trauma, endobronchial microbiological organisms, purulent secretion, aspiration or malignancy) or not (Non-Standard Donor Group; Non-SDG).

Results: A total of 57 pediatric lung transplantations was performed, of which 27 donors fulfilled standard donor criteria, and 30 did not. Preoperative characteristics including age (12.3 ± 4.1 vs.12.9 ± 3.7 years, p = 0.71), admission to ICU (37.0 vs. 50%, p = 0.42), mechanical ventilation (14.8 vs. 10.0%, p = 0.70) and ECMO support (11.1 vs. 23.3%, p = 0.30) of both groups were not significantly different.

Perioperative characteristics including intraoperative use of extracorporeal circulation and cold ischemic times also did not differ. In the Non-SDG, more atypical volume reductions of the donor lungs were performed (0 vs. 16.7%, p = 0.05), but the frequency of postoperative ECMO support was similar in both groups.

Postoperative complications including primary graft dysfunction grade 2 or 3 or postoperative dialysis did not differ. Non-SDG recipients were significantly shorter on mechanical ventilation (Median 2 [1–2] vs. 1 [1–2] days, p = 0.04) following surgery, however, total ICU stay (4 [2–12] vs. 3 [2–10] days, p = 0.54) and total hospital stay (33 [22–48] vs. 33.5 [23.5–47] days, p = 0.67) were similar.

Pulmonary function testing at discharge from the initial hospital stay, after 1 year and at last assessment did not show significant differences. Freedom from CLAD at 1 (100 vs. 100%, p > 0.99) and 5 years (57.9 vs. 71.7%, p = 0.78) o showed no significant differences between both groups.

Survival up to 5 years (67.9 vs. 90.5%, p = 0.35) after transplantation was not statistically significantly different, but was numerically higher in the Non-SDG group.

Conclusion: ISHLT Non-standard Criteria Donor lungs can safely be used for pediatric lung transplantation without compromising short- and midterm results.