Worse Survival for Recipients of Lungs From Smokers

(HealthDay News) – Recipients of lungs from donors with a positive smoking history have worse three-year survival, but their probability of survival is better than for those who remain on the waiting list.

Robert S. Bonser, MD, from the University of Birmingham in the United Kingdom, and colleagues investigated the consequences of donor smoking on three-year survival after adult lung transplantation from brain-dead donors. Of the 1,295 lung transplantations performed between July 1999–December 2010, 39% were from donors with a positive smoking history. The effect of acceptance of lungs from donors who smoked was compared with the effect of remaining on the waiting list for a potential transplant from a donor with no smoking history.

The researchers found that receiving a lung from a donor with a smoking history correlated with worse three-year survival compared to receiving a lung from a donor with no smoking history (unadjusted hazard ratio [HR], 1.46; adjusted HR, 1.36). Recipient age, donor-recipient cytomegalovirus matching, donor-recipient height difference, donor’s gender, and total ischemic time independently affected survival. Thirty-seven percent of the 2,181 patients registered on the waiting list died or were removed without receiving a transplant. Compared with those who remained on the waiting list, patients who received lungs from donors with a positive smoking history had a lower risk of death after registration (unadjusted HR, 0.79). The risk-adjusted hazard was 0.6 and 0.39 for patients with septic or fibrotic lung disease, respectively.

“Donors with positive smoking histories provide nearly 40% of the lungs available for transplantation. Rejection of this donor-organ resource would increase waiting-list mortality and is ill advised,” the authors conclude.

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