Single-lung transplantation can be performed with acceptable outcomes using selected donors with heavy smoking history.

Background: We attempt to determine if adult, single-lung transplantation could be performed with acceptable results in heavy-smoking donors (HSDs; > 20 pack-years).

Methods: The United Network of Organ Sharing database was examined for adult single-lung transplantation from 2005 to 2011.

Results: Of the 3,704 single-lung transplantations, 498 (13.4%) were from HSDs. The 2 groups were similar in recipient age (60.6 vs. 60.7 years, p = 0.20), male gender (61.3% vs. 59.8%, p = 0.54), ischemic time (4.1 vs. 4.2 hours, p = 0.11), and pre-transplant forced expiratory volume in 1 second (FEV1; 41.1% vs. 40.0% predicted). Recipients of HSDs had lower lung allocation score (39.7 vs. 38.0, p = 0.02), less human leukocyte antigen mismatches (4.6 vs. 4.5, p = 0.01), and higher class I panel reactive antibody (2.9% vs. 3.8%, p < 0.001). HSDs were older (33.0 vs. 41.3 years, p < 0.001) and less likely male (62.5 vs. 56.0%, p = 0.01). Recipients with HSDs had longer length of stay (20.5 vs. 23.0 days, p < 0.001) and lower peak FEV1 after single-lung transplantation (80.1% vs. 73.4%, p < 0.001). Freedom from bronchiolitis obliterans syndrome (p = 0.64), post-single-lung transplantation decrement in FEV1 (p = 0.07), and median survival (1,516 vs. 1,488 days, p = 0.10) were similar. Multivariable analysis found receiving lungs from actively smoking HSDs was associated with mortality (hazard ratio [HR], 1.23, 95% confidence interval [CI], 1.05-1.45; p = 0.01). Use of HSDs who were not actively smoking was not associated with mortality (HR, 0.84; 95% CI, 0.59-1.19; p = 0.33). Mortality was associated with recipient age, longer ischemic time, race mismatch, class I panel reactive antibody > 10%, mechanical ventilation, and extracorporeal membrane oxygenation as a bridge to transplantation.

Conclusions: Although single-lung transplantation with actively smoking HSDs results in worse results, outcomes are acceptable and should continue to be considered.