Risky Business: Taking the Stigma Out of High-Risk Donation in Lung Transplantation.

Background: Outcomes data for high-risk donors (HRD) for transplantation are limited. We sought to elucidate the outcomes of lung transplant (LTx) recipients who received HRDs.

Methods: We retrospectively reviewed the United Network for Organ Sharing (UNOS) registry from January 2005 to June 2013 to identify patients undergoing LTx. The Student t test and χ(2) test were used to identify differences in outcomes. A Cox proportional hazard model was developed to identify independent predictors of outcomes for HRD recipients.

Results: We identified 12,737 patients who underwent LTx. A total of 999 (7.8%) recipients received allografts from HRDs. Recipients in both the HRD and the non-HRD (NHRD) groups were similar. The HRDs had significantly higher rates of negative social behaviors and were likely to be thin young males who had died traumatically. Survival analysis demonstrated no survival benefit for patients receiving allografts from NHRDs (p = 0.63). Interestingly, HRDs did not have significantly higher viral loads, including hepatitis C virus (HCV) antibody, hepatitis B core antibody (HBcV), or hepatitis B surface antigen. When controlling for age, sex, and lung allocation score of the recipient, HRD status was not significantly detrimental to survival.

Conclusions: Recipients receiving allografts from HRDs had at least equivalent survival to NHRD recipients. Our study supports the use of high-risk donation given limited resources. Centers interested in using these donors should educate prospective recipients willing to consider this option.