Thoracic: Lung Transplantation
Outcomes of lung transplantation at a Canadian center using donors declined in the United States

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Abstract

Objectives

Donor lungs from the United States can be offered by US organ procurement organizations to Canada if no American centers accept them. The purpose of this study is to evaluate outcomes of patients undergoing transplant at a single center in Canada using declined lungs from the United States and to compare these outcomes to patients receiving lungs from Canadian donors.

Methods

A single-center retrospective review of recipients receiving lung transplantation between January 2009 and October 2019 was performed. An Organ Procurement and Transplantation Network standard transplant analysis and research-limited dataset as of August 17, 2021, was provided by the United Network for Organ Sharing. De-identified patient-level data were extracted from the standard transplant analysis and research file to identify lung offers made by US organ procurement organizations, declined by US lung centers, and transplanted by the University Health Network within the study time frame. We divided the analysis into 2 groups: recipients receiving donor lungs from Canada and recipients receiving donor lungs from the United States. Donor and recipient characteristics between the 2 groups were compared. Primary end point was proportional survival over a 10-year period. Secondary end points included 30-day mortality, intensive care unit and hospital length of stay, severe primary graft dysfunction, and incidence of chronic lung allograft dysfunction.

Results

During the study period, 1424 lung transplants were performed at our center. Of these, 124 (8.7%) were performed using donors from the United States. The incidence of transplants using US donors increased from 5% (5 out of 102) in 2009 to 15% (30 out of 200) in 2018. US donors were younger (aged 41 vs 47 years; P = .004), less likely to be from donors after cardiac death (9.6% vs 20%; P = .008), had higher use of ex vivo lung perfusion (EVLP, 46% vs 27%; P = .0002), and higher incidence of positive nucleic acid test for hepatitis C (16% vs 0.7%; P = .0001). Although the incidence of EVLP utilization was higher in the US lungs versus Canada lungs, more than half of US lungs (54%) proceeded directly to transplantation. Similar short- and long-term outcomes were observed between the 2 groups, including overall survival (hazard ratio, 1.12; 95% CI, 0.85-1.47; P = .40)

Conclusions

Lung transplantation using donor lungs declined by multiple centers in the United States resulted in similar short- and long-term outcomes compared with donor lungs offered in Canada.

Section snippets

Study Design

We performed a single-center retrospective review of recipients receiving lung transplantation between January 2009 and October 2019 at Toronto Lung Transplant Program. This study was approved by our institutional research ethics board (No. 17-5280) for a retrospective review of data prospectively collected in our database. We divided the analysis into 2 groups: recipients receiving donor lungs from Canada or the United States. Donor and recipient characteristics between the 2 groups were

Donor Characteristics

During the study period, 1424 lung transplants were performed at our center. Of these, 124 (8.7%) were performed using donors from the United States. The number of lung transplants per year using US donors is shown in Figure 1, A. The incidence of transplants using US donors increased from 5% (5 out of 102) in 2009 to 15% (30 out of 200) in 2018 (Figure 1, B). Twenty-one OPOs in the United States offered lungs to our center during the study period. Before donor lungs were offered to our center,

Discussion

In this report, we demonstrate that transplantation of donor lungs that were declined in the United States and offered to Canada can provide excellent outcomes that are similar to primary offers to our center from Canadian donors. US donors were younger, less likely to be DCD donors, and more commonly tested positive for HCV. We believe the availability of a high-performance EVLP program at our center stimulated American OPOs to send offers more liberally to our program. Yet, this technology

Conclusions

Lung transplantation using donor lungs declined by multiple centers in the United States, resulting in similar short- and long-term outcomes compared with donor lungs offered in Canada. We believe this work may stimulate US lung transplant centers to further evaluate the current pool of declined donor lungs in the United States.

References (8)

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This study was funded by internal department funding sources.

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