By Liam Davenport, medwireNews Reporter
Although lung transplantation from donors with a positive smoking history is associated with worse outcomes than with lungs from non-smoking donors, survival is still better than remaining on the waiting list, say UK researchers.
"Rejection of this donor-organ resource would increase waiting-list mortality and is ill advised," say Robert Bonser, from Queen Elizabeth Hospital in Birmingham, and colleagues. "However, patients should be informed that the use of such lungs could reduce their lifetime."
"Further research is needed to establish the threshold value for donor pack-year history above which the risk for the recipient increases to a degree that compromises treatment benefit," they write in The Lancet.
Using data from the UK Transplant Registry, the team found that, between 1999 and 2010, 2181 individuals with end-stage lung disease were added to waiting lists and 1295 lung transplantations, from 1221 donors, were performed. The yearly transplantation rate increased by 25%, from 130 in 1999 to 162 in 2010.
Of the 1295 lung transplantations performed, 39% involved lungs from donors with positive smoking histories, and the proportion of transplantations involving such donors did not change over time.
A total of 536 lung-transplant recipients died during the study period. The median post-transplantation survival time was 4.9 years among those who received transplants from donors with positive smoking histories, compared with 6.9 years with transplants from nonsmokers. The unadjusted hazard ratio for death at 3 years for donor history of smoking versus no smoking history was 1.46.
Significant risk factors for 3-year survival were recipient age, donor-recipient cytomegalovirus matching, donor-recipient height difference, donor's gender, and total ischemic time. Multivariate analysis indicated that the adjusted hazard ratio for death at 3 years for donor history of smoking was 1.36.
Of 2100 waiting list patients analysed, 55% received a transplant, while 38% died or were removed from the list, and 6% were still on the transplantation list at the time of analysis. Patients who received lungs from donors with positive smoking histories had a significantly lower unadjusted hazard ratio for death after registration than those who waited for a potential transplant from a donor with a negative smoking history, at 0.79.
The risk-adjusted hazard ratios for patients with septic or fibrotic disease registered between 1999 and 2003 were 0.60 and 0.39, respectively.
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