DOES THE MODE OF DONOR DEATH INFLUENCE THE EARLY OUTCOME OF LUNG TRANSPLANTATION - A REVIEW OF LUNG TRANSPLANTATION FROM DONORS INVOLVED INMAJOR TRAUMA

Background: Pulmonary dysfunction, often delayed in presentation, is a mong the sequelae of major trauma. Transplantation of lungs from donor s involved in major trauma therefore carries a risk of early graft dys function. This study was conducted to assess this risk. Methods: A ret rospective comparison of the outcome from 123 donors (57 donors result ing from major trauma, group T, and 66 donors with nontraumatic origin , group NT) in 125 consecutive technically successful lung or heart-lu ng transplantations. Variables analyzed included the following: clinic al and bacteriologic details of donors and indexes of early graft dysf unction in the recipients. Results: Group T donors were more likely to be younger and male (p < 0.05) and more likely to have had lung venti lation for over 48 hours (p < 0.05) than group NT donors. Microbial co ntamination of routine donor bronchial lavage (72 of 122, 61%) was no higher in group T (34 of 57, 60%), but, in this group, enteric gram-ne gative bacilli were more common (30% versus 7%; p < 0.05). Male patien ts were more likely to receive lungs from group T donors (35 male, 23 female), and female patients were more likely to receive lungs from gr oup NT donors (27 male, 40 female). Mode of donor death did not affect the following indexes of early graft function: length of postoperativ e ventilation, ratio of arterial oxygen tension to fractional concentr ation of inspired oxygen at 1 or 24 hours after transplantation, or th e incidence of diffuse alveolar damage in lung biopsy specimens at 7 d ays. Thirty-day mortality (28%) was no higher among recipients of grou p T lungs, but six recipient deaths were donor-related (donor-transmit ted pneumonia in five and donor acquired fat embolism in one case). Co nclusion: The use of donors involved in major trauma does not increase the risk of early complications after lung transplantation providing their specific characteristics are recognized.