Examining ABO compatible donors in double lung transplants during the era of lung allocation score

Background. The short-term and long-term effect ofusing ABO compatible donors in the era of lung allocationscore is unknown. This study determined if carefullyselected ABO compatible donors could be used in doublelung transplantation (DLT) with good outcomes.

Methods. The United Network for Organ Sharingdatabase was retrospectively reviewed for adult DLTfrom May 2005 to December 2011.

Results. Of 6,655 double lung transplants, 493 (7.4%)were with ABO compatible donors and 6,162 (92.6%) werewith ABO identical donors. In multivariate analysis, use ofABO compatible donors was not associated with mortalityat 30 days (HR, 1.16; 95% CI, 0.76 to 1.79, p [ 0.49), 1 year(HR, 1.10; 95% CI, 0.86 to 1.42, p [ 0.46), and 5 years (HR,1.06; 95% CI, 0.83 to 1.34, p [ 0.65). Variables associatedwith mortality at 5 years were donor female sex, donor age60 years or greater, prolonged ischemic time, increasingrecipient creatinine, recipient age, race mismatch, andmechanical ventilation or extracorporeal membraneoxygenation as a bridge to transplantation. Length of staywas longer in the ABO compatible group (30.9 vs 25.9 days,p [ 0.001). Acute rejection episodes on index hospitalization(8.8 vs. 8.9%, p [ 1.00), peak posttransplant forcedexpiratory volume in 1 second (FEV1) (82.7 vs 79.7%,p [ 0.053), and decrement in FEV1 over time were notdifferent (p[0.13). Freedomfrombronchiolitis obliteranssyndrome was similar (1,475 vs 1,454 days, p[0.17).

Conclusions. The use of ABO compatible donors in theera of lung allocation score was not associated with shorttermor long-term mortality and resulted in equivalentposttransplant lung function. A DLT with carefullyselected ABO compatible donors can result in excellentoutcomes.