Lung donation from hospital-based care unit extends transplant recipient survival

Key takeaways:

• Hospital-based donor care unit lung recovery lengthened survival by 117 days.
• Independent vs. hospital-based donor care unit lung recovery was linked to a heightened adjusted risk for graft failure.

Lung transplant recipients lived for a longer time if they received lungs from a donor cared for in a hospital-based vs. independent donor care unit, according to results published in JAMA Network Open.

“Clinicians should know that the system of deceased organ donor management is changing in the U.S. and that centralizing donors into donor care units may impact transplantation and survival outcomes of patients with end-stage lung and other organ disease,” Emily A. Vail, MD, MSc, assistant professor of anesthesiology and critical care at University of Pennsylvania’s Perelman School of Medicine, told Healio.

In a retrospective cohort study, Vail and colleagues evaluated 5,149 deceased lung donors who had their organs recovered between April 2017 and June 2022 and 1,657 transplant recipients (mean age, 58.6 years; 64.4% male) to find out how survival differed between those who received a lung from a donor cared for in an independent unit and those who received a lung from a donor cared for in a hospital-based unit.

Within the donor cohort, more donors had organ recovery in independent vs. hospital-based donor care units (71.5% vs. 28.4%).

Researchers observed a significantly greater percentage of lung donations from independent donor care units than hospital-based units (33.5%; n = 1,233 vs. 28.5%; n = 418; P < .001), and similarly, more individuals in the study’s recipient cohort had lung(s) transplanted from an independent donor care unit (74.5%; n = 1,250 vs. 24.6%; n = 407).

Of the 1,651 donors who donated at least one lung for transplant, those in hospital-based donor care units significantly differed from those in independent care units based on race (white, 51.7% vs. 65.2%), ethnicity (Hispanic, 22.2% vs. 13.1%) and pulmonary infection (77.8% vs. 68%).

Switching to transplant recipients, researchers also observed several significant differences between those with lungs from a hospital-based donor care unit and those with lungs from an independent donor care unit, including:

• race (white, 67.1% vs. 76.1%; Asian, 5.7% vs. 2.6%);
• ethnicity (Hispanic, 15.2% vs. 11.8%);
• COPD (21.6% vs. 27.1%);
• restrictive lung disease (71% vs. 62.3%);
• 6-minute walk distances before transplant (median, 668 ft vs. 767 ft); and
• lung allocation scores at transplant match (median, 39 vs. 37.9).

Over the median follow-up period of 734 days following transplantation, a significantly greater proportion of transplant recipients of lungs from an independent vs. a hospital-based donor care unit experienced graft failure (defined as death or retransplantation) (30.2% vs. 22.9%; P = .005).

Mean survival length among those who received a lung from an independent donor care unit was 1,548 days, whereas the survival time found among those who received a donor lung from a hospital-based unit was 1,665 days, an additional 117 days (P = .04).

“Because we expected donor management to be similar between types of donor care units and many other non-donor factors impact lung transplant recipient survival, we hypothesized that we would not find a difference, [so] we were surprised to find that recipient survival was longer among patients who received transplants from donors managed in units co-located with hospitals,” Vail said.

Researchers further found that independent vs. hospital-based donor care unit lung recovery was linked to a heightened risk for graft failure (adjusted HR = 1.85; 95% CI, 1.28-2.65) in a Cox proportional hazards model adjusted for several donor and recipient variables associated with recipient survival.

“This study builds on previous studies that compare short-term donation outcomes (eg, numbers and types of organs transplanted) between adult deceased organ donors after brain death who are managed in donor care units to traditional hospitals,” Vail said. “Study findings do not apply to deceased infant or pediatric donors, to deceased organ donors after circulatory death, or living organ donors who receive care in hospitals and are rarely transferred to donor care units.”

Looking ahead, Vail told Healio studies should focus on how to improve outcomes for donors and recipients.

“Future studies will examine which factors differ between types of donor care units (eg, donor selection or clinical donor management) to determine whether these practices may be modified to improve outcomes for donors in all settings,” she said.

Reference:

• Penn study finds better survival rates for recipients of lungs from hospital-based donor care units compared to independent donor care units. https://www.pennmedicine.org/news/news-releases/2024/june/research-compares-lungs-from-hospital-based-donor-care-units-to-independent-donor-care-units. Published June 25, 2024. Accessed June 25, 2024.