Does donor arterial partial pressure of oxygen affect outcomes after lung transplantation? A review of more than 12,000 lung transplants

IntroductionIn lung transplantation (LTx), the arterial partial pressure of oxygen (PaO2) is traditionally regarded as critical information for assessment of donor lung function. Each center sets its own thresholds; by convention, a donor PaO2 of less than 300 mm Hg has been considered disqualifying. Limited literature exists to support such a practice. We analyzed all LTxs performed in the United States over a 9-year period to assess the effect of donor PaO2 on graft survival.MethodsThe United Network for Organ Sharing (UNOS) database was queried for LTx (January 2000-November 2009). Of 12,545 LTx performed, 12,045 (96%) had donor PaO2 data on a fraction of inspired oxygen of 1.0, recorded at the time of procurement.ResultsMean donor PaO2 was 407 ± 140 mm Hg. The majority of LTxs had a donor PaO2 greater than 300 mm Hg (9593 (80%]) whereas PaO2 was 200 mm Hg or less in 1830 (15%) and 201 to 300 in 582 (5%) donors. Use of donors with a PaO2 of less than 200 increased over time from 5% (45) in 2000 to 21% (295) in 2009 (P = .002). Kaplan-Meier survival analysis showed no difference in graft survival with differing donor PaO2s, irrespective of whether patients had a single or double LTx. A Cox multivariable analysis of 21 donor characteristics demonstrated that donor PaO2 had no association with graft survival.ConclusionsDonor PaO2 levels did not affect graft survival. The use of donors with lower PaO2s could substantially increase the donor pool. We are not suggesting that donor PaO2 is not important when assessing potential lung donors but its level of importance in regard to other criteria appears less than previously believed.