This article is more than 5 years old. Information may no longer be current.

Posttransplant survival similar with increased-risk vs. standard-risk donor lungs

For patients who underwent lung transplantation, survival rates were comparable between those who received lungs from donors who were considered high risk for certain infections and those who received lungs from standard-risk donors, according to a study published in the Journal of Thoracic and Cardiovascular Surgery.

“Our reason for conducting this study was twofold. First, we noticed that many patients on our waitlist were turning down organs from ‘increased-risk’ donors. Prior studies showed this behavior was common, and we wanted to learn more about the posttransplant experience of recipients who accepted lungs from increased-risk donors,” Carli J. Lehr, MD, MS, from the Respiratory Institute at Cleveland Clinic, wrote in an email to Healio Pulmonology.

“Second, previous research studying disease transmission risk in organ transplantation concentrated on an older definition: ‘high-risk’ donors. This definition changed in 2013 from high-risk to increased-risk donors to include risk factors for more diseases that could be transmitted by organ transplant.”

This distinction is important, Lehr noted, because before the change, less than 10% of donors were classified as high risk, whereas now, nearly one-quarter of donors are classified as increased risk.

“This means that recipients who do not accept increased-risk donors may be missing out on up to 25% of donor lungs that could lead to a lifesaving lung transplant,” she said.

Comparable outcomes

For the study, Lehr and colleague evaluated Scientific Registry of Transplant Recipients data for patients who underwent lung transplant from 2006 to May 2017. They then divided recipients into two cohorts — high-risk donors and increased-risk donors — based on which definition was used. Recipients who underwent transplant from 2006 to October 2013 were included in the high-risk donor cohort and those who underwent transplant from 2014 to May 2017 were included in the increased-risk donor cohort. Both cohorts were then compared with matched recipients who received lungs from standard-risk donors.

Of the 18,490 lung transplant recipients included in the analysis, 64% were transplanted during the high-risk donor definition period and 36% were transplanted during the increased-risk donor definition period. Use of nonstandard infectious risk donors increased after the definition change (8% high-risk donors vs. 22% increased-risk donors; P < .001).

When compared with the matched standard-risk donor recipients, patient survival was similar for both high-risk donor recipients (HR = 0.97; 95% CI, 0.83-1.14) and for increased-risk donor recipients (HR = 1.07; 95% CI, 0.9-1.27). Graft survival was also comparable among high-risk donor recipients (HR = 0.99; 95% CI, 0.85-1.16) and increased-risk donor recipients (HR = 1.07; 95% CI, 0.9-1.26), as compared with standard-risk donor recipients.

Additionally, the incidence of acute rejection within 1 year was similar among patients who received an organ from standard-risk donors and those who received organs from high-risk donors (OR = 1.2; 95% CI, 0.86-1.68) or increased-risk donors (OR = 0.87; 95% CI, 0.69-1.1).

“Our study results were consistent with what we were seeing in our clinical practice and it was encouraging to see that recipients who received lungs from an increased-risk donor did not have worse patient or graft survival and did not experience more rejection in the first year after transplant,” Lehr said.

Refining terminology

Hopefully, these findings can dispel some of the concern surrounding use of organs from donors not classified as standard risk, according to Lehr.

“The use of the label ‘increased risk’ has been shown to impact utilization rates across organs with very low risks of donor disease transmission. Our study lends support to this body of literature supporting that posttransplant outcomes are not inferior to recipients of lungs from standard-risk donors,” she said.

Lehr also noted that future examination of the terminology used to define donor risk is warranted.

“There have been multiple studies in the field of transplantation indicating that the increased risk designation reduces organ utilization yet is associated with low rates of disease transmission,” she told Healio Pulmonology. “This has led to a public comment period addressing potential changes to this definition. We hope this work adds to the field of knowledge promoting continued efforts from the transplant community to optimized and refine the Public Health Service Guideline for Reducing HIV, Hepatitis B Virus and Hepatitis C Virus Through Organ Transplantation.” – by Melissa Foster

For more information:

Carli Lehr, MD, MS, can be reached on Twitter: @CarliLehrMD.

Disclosures: This study was supported by a grant from the Center for Population, Lerner Research Institute. The authors report no relevant financial disclosures.