The following is a summary of the “Assessing donor organ quality according to recipient characteristics in lung transplantation,” published in the February 2023 issue of Thoracic and cardiovascular surgery by Wadowski, et al.

While overall donor organ utilization remains low, there is a severe shortage of donor lungs concerning need. Organ quality is the most common reason for rejection, but selection criteria can vary. Their goal with this analysis was to characterize quality-based variations in lung utilization among recipient pools that differ clinically. The Scientific Registry of Transplant Recipients was mined for information on lung donors and recipients from April 2006 to September 2019. Based on their lowest score across criteria, organs were assigned to the ideal, standard, or extended quality categories. Subanalyses were conducted according to the procedure, age, lung allocation score, time period, and various definitions of extended quality. 

Transplant recipients’ characteristics and the likelihood of survival were evaluated concerning organ quality. During the study period, 156,022 lungs were evaluated, and 25,777 (16.5%) were used in transplants. The distribution of transplant quality was the same for both unilateral and bilateral procedures. Candidates under the age of 30 were more likely to receive standard lungs (9.5% vs. 8.2%) or ideal lungs (14.7 vs. 12.3%; all P<.01) than those over the age of 30. Comparing the distribution by lung allocation score, the quartile revealed minimal absolute differences (<2%). 

Over time, there was a rise in the use of long-lasting, high-quality donors. Both unadjusted and Cox regression analyses found no difference in survival between donor categories at 1 and 3 years post-transplant. More and more transplants in a national sample involve lungs of extended quality. When deciding which organs to give, doctors consider the recipient’s age and lung allocation score. However, relative quality differences are small, and only organs with multiple extended qualifying characteristics have any negative impact on outcomes.

Source: sciencedirect.com/science/article/abs/pii/S002252232200352X