EARLY LUNG ALLOGRAFT FUNCTION IN TWIN RECIPIENTS FROM THE SAME DONOR - RISK FACTOR-ANALYSIS

Background. Transplantation of lung allografts from the same donor int o 2 recipients (''twinning'') provides an opportunity to study recipie nt and donor factors that influence early allograft function. Methods. Twenty-seven pairs of recipients were identified and evaluated using multivariate logistic regression analysis (p < 0.05). Four measures of early graft function were analyzed: alveolar-arterial gradient in the operating room, first alveolar-arterial gradient in the intensive car e unit, alveolar-arterial gradient at 24 hours, and days of mechanical ventilation. Results. Analysis of the pooled data without regard to p airing showed that alveolar-arterial gradient in the operating room wa s influenced by donor age, length of donor hospitalization, recipient mean pulmonary artery (PA) pressure at unclamping, and transplantation of a left lung. The alveolar-arterial gradient in the intensive care unit was correlated with donor age, donor cause of death, and mean PA pressure on arrival in that unit. Only mean PA pressure remained signi ficant at 24 hours. Days of mechanical ventilation was determined by m ean PA pressure on arrival in the intensive care unit, drop in mean PA pressure during operation, and diagnosis of the recipient. In the pai red analysis, receiving a left lung, recipient diagnosis (pulmonary hy pertension worse than others), and need of cardiopulmonary bypass were significantly associated with immediate graft dysfunction, although t hese influences did not persist beyond the immediate postoperative per iod. Donor arterial oxygen tension and time of ischemia were not signi ficant predictors in any analysis. Conclusions. Immediate allograft fu nction was associated with donor-related characteristics initially, bu t these lost importance over the ensuing 24 hours. Recipient PA pressu re was an immediate and persisting influence. In the analysis of diffe rences in function between the members of each pair, transplantation o f the left lung, recipient diagnosis, and cardiopulmonary bypass were identified, but their influence did not persist beyond the first 6 hou rs.