The evaluation of donor lungs heavily depends on the subjective judgment of the retrieval
surgeon. As a consequence, acceptance rates vary significantly among transplant centers.
We aimed to determine donor ventilation parameters in a prospective study and test
if they could be used as objective quality criteria during organ retrieval.A prospective
evaluation of lung donors was performed in 3 transplant centers. Ventilation parameters
were collected at the time of retrieval using a standardized ventilation protocol.
Recipient length of mechanical ventilation (LMV) was defined as the primary end point,
and collected data was used to build linear models predicting LMV.In total, 166 donors
were included in this study. Median LMV after transplantation was 32 hours (interquartile
range: 20-63 hours). Peak inspiratory pressure and dynamic compliance (Cdyn) at the
time of retrieval, but not the partial pressure of oxygen/fraction of inspired oxygen
(P/F) ratio, correlated with recipient LMV in Spearman correlations (r = 0.280, p
= 0.002; r = -0.245, p = 0.003; and r = 0.064, p = 0.432, respectively). Linear models
were built to further evaluate the impact of donor ventilation parameters on LMV.
The first model was based on donor P/F ratio, donor age, donor intubation time, donor
smoking history, donor partial pressure of carbon dioxide, aspiration, chest trauma,
and pathologic chest X-ray. This model performed poorly (multiple R-squared = 0.063).
In a second model, donor ventilation parameters were included, and Cdyn was identified
as the strongest predictor for LMV. The third model was extended by recipient factors,
which significantly improved the robustness of the model (multiple R-squared = 0.293).In
this prospective evaluation of donor lung parameters, currently used donor quality
criteria poorly predicted recipient LMV. Our data suggest that Cdyn is a strong donor-bound
parameter to predict short-term graft performance; however, recipient factors are
similarly relevant.
