TY - JOUR
T1 - Donor Factors Are Associated With Bronchiolitis Obliterans Syndrome After Lung Transplantation
AU - Hennessy, Sara A.
AU - Hranjec, Tjasa
AU - Swenson, Brian R.
AU - Kozower, Benjamin D.
AU - Jones, David R.
AU - Ailawadi, Gorav
AU - Kron, Irving L.
AU - Lau, Christine L.
N1 - Funding Information:
This work was supported in part by Health Resources and Services Administration contract 234-20050370011C. The content is the responsibility of the authors alone and does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does it mention trade names, commercial products, or organizations imply endorsement by the U.S. Government.
PY - 2010/5
Y1 - 2010/5
N2 - 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 (Pao2) developed more BOS (p < 0.0001). Donor high Pao2, 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 Pao2 in the donor is an independent predictor of BOS development.
AB - 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 (Pao2) developed more BOS (p < 0.0001). Donor high Pao2, 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 Pao2 in the donor is an independent predictor of BOS development.
UR - http://www.scopus.com/inward/record.url?scp=77953034586&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=77953034586&partnerID=8YFLogxK
U2 - 10.1016/j.athoracsur.2010.01.060
DO - 10.1016/j.athoracsur.2010.01.060
M3 - Article
C2 - 20417777
AN - SCOPUS:77953034586
SN - 0003-4975
VL - 89
SP - 1555
EP - 1562
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 5
ER -