Impact of extended-criteria donor use on lung transplantation survival outcomes

Results from a retrospective cohort study, evaluating the impact of extended-criteria donor (ECD) use according to recipient urgency status on survival outcomes in 1,251 adult lung transplant recipients registered with the Korean Network for Organ Sharing (KONOS; 2010–2023), were published in the Journal of Korean Medical Science by Yeo et al. Patients were stratified into five urgency categories (status 0–4) based on predefined medical criteria. Status 0 was defined as hospitalization with mechanical ventilation (MV) and/or extracorporeal membrane oxygenation (ECMO).

Key data: Among recipients, 33.7% received ECD lungs and 66.3% received standard criteria donor (SCD) lungs. In multivariable Cox regression analysis, recipient age (hazard ratio [HR], 1.02; 95% confidence interval [CI], 1.01–1.03; p < 0.001), urgency status 0 (HR, 1.62; 95% CI, 1.30–2.01; p < 0.001), and ECD use (HR, 1.44; 95% CI, 1.17–1.77; p = 0.001) were independently associated with increased 1-year mortality. In subgroup analysis, ECD use was associated with higher mortality vs SCD use in urgency status 1–4 recipients (p < 0.001), but not status 0 recipients (p = 0.056). Among elderly (≥65 years) and younger (<65 years) recipients, ECD use was associated with higher mortality vs SCD use in status 1–4 (p = 0.001 and p = 0.014, respectively), but not in status 0 (p = 0.071 and p = 0.226, respectively).

Key learning: ECD use is associated with higher 1-year mortality in urgency status 1–4 recipients, irrespective of age. In status 0 recipients, this effect differs by age. These data highlight the importance of considering recipient urgency and age in donor lung selection.