Short-term and long-term outcomes of lung transplantation from marginal donors: a single-center retrospective study

Background: To expand the donor pool, medical centers worldwide are applying marginal donor lungs in clinical settings. We carried out this research to reveal the short-term and long-term outcomes of marginal lung donor transplantation.

Methods: We performed retrospective research using data from patients who underwent lung transplantation (LT) in The Affiliated Wuxi People's Hospital of Nanjing Medical University, Jiangsu Province, China, between 2018 and 2022 to compare the short-term and long-term outcomes of standard donors and marginal donors.

Results: A total of 553 cases were incorporated in this study. The perioperative mortality of recipients who received marginal donor lungs was around 20.8%, compared with 13.4% in the standard donor recipients (P=0.03). There were no significant differences between the two groups in terms of mechanical ventilation or extracorporeal membrane oxygenation (ECMO), length of intensive care unit and hospital stay, occurrence of primary graft dysfunction, and prevalence of acute rejection. The 1-year survival rate for recipients in the standard group and marginal group was 71.7% and 54.2% (P<0.001), respectively. There was a worse survival rate in the subgroups of age >55 years, smoking ≥20 pack-years, and abnormal chest radiographs; however, the 1-year survival rate in the subgroup analysis of donors with ratio of arterial oxygen partial pressure to fraction of inspired oxygen (PaO₂/FiO₂) <300 mmHg and purulent secretions on bronchoscopy was not significantly different.

Conclusions: Our findings suggest that marginal donor recipients can expect to have a lower survival rate than standard donor recipients. However, marginal lung transplant recipients could also gain benefit equivalent to that provided by standard donor LTs in both the short- and long-term when proper assessment and management strategies are implemented.