Traumatically Brain-Injured Donors and the Impact on Lung Transplantation Survival

Todd C. Crawford, Cecillia Lui, J. Trent Magruder, Alejandro Suarez-Pierre, Jinny Ha, Robert Higgins, Stephen Broderick, Christian Merlo, Bo Soo Kim, Errol Bush

Research output: Contribution to journalArticle

Abstract

Background: Concern has been raised over inferior lung transplantation survival associated with traumatic brain injury (TBI) organ donors. Our purpose was to explore the relationship between TBI donors and lung transplantation survival in the lung allocation score (LAS) era. Methods: We queried the United Network for Organ Sharing Scientific Registry of Transplant Recipients and identified all adult (≥18 years) lung transplantations performed from May 4, 2005, to December 31, 2015. Recipients were dichotomized based on donor cause of death, TBI versus non-TBI, propensity score across eight variables (final LAS, intensive care unit admission before transplantation, extracorporeal membrane oxygenation before transplantation, donor age 50 years or older, cytomegalovirus antibody recipient/donor+, ischemia time, annual center transplantation volume, single versus double lung transplantation), and matched 1:1 without replacement. Our primary outcomes were survival at 1, 3, and 5 years by Kaplan-Meier method. Results: A total of 17,610 patients underwent isolated lung transplantation over the study period at 75 different transplantation centers. TBI was the leading cause of death in the donor population: 47% of all donors. Propensity score matching generated 6,782 well-matched donor TBI versus non-TBI pairs (all covariate p > 0.2). Risk-adjusted survival was similar between recipients of TBI donors versus non-TBI donors at 1 year (86% versus 86%, log-rank p = 0.27), 3 years (68% versus 68%, log-rank p = 0.47), and 5 years (55% versus 54%, log-rank p = 0.40). Conclusions: In the largest analysis of TBI donors and the impact on lung transplantation survival to date, we found similar survival out to 5 years in lung transplant recipients of TBI versus non-TBI donors, alleviating concerns over continued transplantation with this unique donor population.

Original languageEnglish (US)
Pages (from-to)842-847
Number of pages6
JournalAnnals of Thoracic Surgery
Volume106
Issue number3
DOIs
StatePublished - Sep 1 2018

Fingerprint

Lung Transplantation
Tissue Donors
Survival
Brain
Transplantation
Brain Injuries
Propensity Score
Lung
Cause of Death
Extracorporeal Membrane Oxygenation
Traumatic Brain Injury
Cytomegalovirus
Population
Intensive Care Units
Registries
Ischemia

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Traumatically Brain-Injured Donors and the Impact on Lung Transplantation Survival. / Crawford, Todd C.; Lui, Cecillia; Magruder, J. Trent; Suarez-Pierre, Alejandro; Ha, Jinny; Higgins, Robert; Broderick, Stephen; Merlo, Christian; Kim, Bo Soo; Bush, Errol.

In: Annals of Thoracic Surgery, Vol. 106, No. 3, 01.09.2018, p. 842-847.

Research output: Contribution to journalArticle

@article{2e789b449c54471a8d19d726c45b9d96,
title = "Traumatically Brain-Injured Donors and the Impact on Lung Transplantation Survival",
abstract = "Background: Concern has been raised over inferior lung transplantation survival associated with traumatic brain injury (TBI) organ donors. Our purpose was to explore the relationship between TBI donors and lung transplantation survival in the lung allocation score (LAS) era. Methods: We queried the United Network for Organ Sharing Scientific Registry of Transplant Recipients and identified all adult (≥18 years) lung transplantations performed from May 4, 2005, to December 31, 2015. Recipients were dichotomized based on donor cause of death, TBI versus non-TBI, propensity score across eight variables (final LAS, intensive care unit admission before transplantation, extracorporeal membrane oxygenation before transplantation, donor age 50 years or older, cytomegalovirus antibody recipient−/donor+, ischemia time, annual center transplantation volume, single versus double lung transplantation), and matched 1:1 without replacement. Our primary outcomes were survival at 1, 3, and 5 years by Kaplan-Meier method. Results: A total of 17,610 patients underwent isolated lung transplantation over the study period at 75 different transplantation centers. TBI was the leading cause of death in the donor population: 47{\%} of all donors. Propensity score matching generated 6,782 well-matched donor TBI versus non-TBI pairs (all covariate p > 0.2). Risk-adjusted survival was similar between recipients of TBI donors versus non-TBI donors at 1 year (86{\%} versus 86{\%}, log-rank p = 0.27), 3 years (68{\%} versus 68{\%}, log-rank p = 0.47), and 5 years (55{\%} versus 54{\%}, log-rank p = 0.40). Conclusions: In the largest analysis of TBI donors and the impact on lung transplantation survival to date, we found similar survival out to 5 years in lung transplant recipients of TBI versus non-TBI donors, alleviating concerns over continued transplantation with this unique donor population.",
author = "Crawford, {Todd C.} and Cecillia Lui and Magruder, {J. Trent} and Alejandro Suarez-Pierre and Jinny Ha and Robert Higgins and Stephen Broderick and Christian Merlo and Kim, {Bo Soo} and Errol Bush",
year = "2018",
month = "9",
day = "1",
doi = "10.1016/j.athoracsur.2018.03.075",
language = "English (US)",
volume = "106",
pages = "842--847",
journal = "Annals of Thoracic Surgery",
issn = "0003-4975",
publisher = "Elsevier USA",
number = "3",

}

TY - JOUR

T1 - Traumatically Brain-Injured Donors and the Impact on Lung Transplantation Survival

AU - Crawford, Todd C.

AU - Lui, Cecillia

AU - Magruder, J. Trent

AU - Suarez-Pierre, Alejandro

AU - Ha, Jinny

AU - Higgins, Robert

AU - Broderick, Stephen

AU - Merlo, Christian

AU - Kim, Bo Soo

AU - Bush, Errol

PY - 2018/9/1

Y1 - 2018/9/1

N2 - Background: Concern has been raised over inferior lung transplantation survival associated with traumatic brain injury (TBI) organ donors. Our purpose was to explore the relationship between TBI donors and lung transplantation survival in the lung allocation score (LAS) era. Methods: We queried the United Network for Organ Sharing Scientific Registry of Transplant Recipients and identified all adult (≥18 years) lung transplantations performed from May 4, 2005, to December 31, 2015. Recipients were dichotomized based on donor cause of death, TBI versus non-TBI, propensity score across eight variables (final LAS, intensive care unit admission before transplantation, extracorporeal membrane oxygenation before transplantation, donor age 50 years or older, cytomegalovirus antibody recipient−/donor+, ischemia time, annual center transplantation volume, single versus double lung transplantation), and matched 1:1 without replacement. Our primary outcomes were survival at 1, 3, and 5 years by Kaplan-Meier method. Results: A total of 17,610 patients underwent isolated lung transplantation over the study period at 75 different transplantation centers. TBI was the leading cause of death in the donor population: 47% of all donors. Propensity score matching generated 6,782 well-matched donor TBI versus non-TBI pairs (all covariate p > 0.2). Risk-adjusted survival was similar between recipients of TBI donors versus non-TBI donors at 1 year (86% versus 86%, log-rank p = 0.27), 3 years (68% versus 68%, log-rank p = 0.47), and 5 years (55% versus 54%, log-rank p = 0.40). Conclusions: In the largest analysis of TBI donors and the impact on lung transplantation survival to date, we found similar survival out to 5 years in lung transplant recipients of TBI versus non-TBI donors, alleviating concerns over continued transplantation with this unique donor population.

AB - Background: Concern has been raised over inferior lung transplantation survival associated with traumatic brain injury (TBI) organ donors. Our purpose was to explore the relationship between TBI donors and lung transplantation survival in the lung allocation score (LAS) era. Methods: We queried the United Network for Organ Sharing Scientific Registry of Transplant Recipients and identified all adult (≥18 years) lung transplantations performed from May 4, 2005, to December 31, 2015. Recipients were dichotomized based on donor cause of death, TBI versus non-TBI, propensity score across eight variables (final LAS, intensive care unit admission before transplantation, extracorporeal membrane oxygenation before transplantation, donor age 50 years or older, cytomegalovirus antibody recipient−/donor+, ischemia time, annual center transplantation volume, single versus double lung transplantation), and matched 1:1 without replacement. Our primary outcomes were survival at 1, 3, and 5 years by Kaplan-Meier method. Results: A total of 17,610 patients underwent isolated lung transplantation over the study period at 75 different transplantation centers. TBI was the leading cause of death in the donor population: 47% of all donors. Propensity score matching generated 6,782 well-matched donor TBI versus non-TBI pairs (all covariate p > 0.2). Risk-adjusted survival was similar between recipients of TBI donors versus non-TBI donors at 1 year (86% versus 86%, log-rank p = 0.27), 3 years (68% versus 68%, log-rank p = 0.47), and 5 years (55% versus 54%, log-rank p = 0.40). Conclusions: In the largest analysis of TBI donors and the impact on lung transplantation survival to date, we found similar survival out to 5 years in lung transplant recipients of TBI versus non-TBI donors, alleviating concerns over continued transplantation with this unique donor population.

UR - http://www.scopus.com/inward/record.url?scp=85051653447&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85051653447&partnerID=8YFLogxK

U2 - 10.1016/j.athoracsur.2018.03.075

DO - 10.1016/j.athoracsur.2018.03.075

M3 - Article

C2 - 29730351

AN - SCOPUS:85051653447

VL - 106

SP - 842

EP - 847

JO - Annals of Thoracic Surgery

JF - Annals of Thoracic Surgery

SN - 0003-4975

IS - 3

ER -