Work

Outcomes of lung transplants utilizing donors from outside the continental United States

Year: 2025

Type: article

Abstract: Purpose Efforts to expand the lung transplant donor pool have included re-evaluating geographic restrictions and accepting longer distances between donor and recipient centers. We evaluated the use of organs from donors outside the continental United States. Methods Adult lung-only transplants from 2005-2022 in the United Network for Organ Sharing database were included and categorized based on donor location (mainland US vs. non-mainland). Survival out to 1- and 5-years post-transplant were evaluated using time-to-event analysis and multivariable Cox regression. Results Of 35,638 transplants, 389 (1.1%) utilized non-mainland donors, including 267 from Puerto Rico, 89 from Alaska, 26 from Hawaii, 6 from Bermuda, and 1 from the US Virgin Islands. Compared to mainland donors, non-mainland donors were younger (median 28 vs. 33 years, p<0.001), more likely to be Hispanic (p<0.001) and male (p<0.001), had lower body mass index (BMI) (24 [22-27] vs. 25 [23-29] kg/m 2 , p<0.001), and were less likely to have a >20 pack-year smoking history (4.9% vs. 9.1%, p=0.004). Recipients of non-mainland vs. mainland lungs were less likely to have restrictive pathology (57.2% vs. 59.5%, p<0.001) and had lower BMI (25 [21-28] vs. 26 [22-29] kg/m 2 , p=0.002). Non-mainland transplants had greater distances between donor and recipient centers (1256 [1072-1405] vs. 148 miles [29-310], p<0.001) and longer ischemic times (7.7 [6.9-8.8] vs. 5.2 [4.2-6.3] hours, p<0.001). Recipients of non-mainland grafts also had longer length of stay (median 19 vs. 17 days, p=0.03). Transplants utilizing non-mainland and mainland donors had similar likelihood of acute rejection prior to discharge (aOR 1.22, p=0.30), as well as post-transplant survival out to 1 (aHR 1.03 [95% CI 0.78-1.35], p=0.86) and 5 years (aHR 0.87 [95% CI.73-1.04], p=0.13). Conclusion Transplants utilizing non-mainland donors had lower-risk donor and recipient characteristics. Despite greater distances and ischemic times, these transplants had similar post-transplant survival compared to transplants using mainland donors. These findings support the use of select donors from outside the mainland US.

Source: JHLT Open

DOI: 10.1016/j.jhlto.2025.100324