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Donor lung pathological abnormalities and recipient outcomes

Introduction: The quality of donor organs may have an impact on early and long-term outcome after lung transplantation. Donors are evaluated according to clinical, functional, radiological and endoscopic features. The histopathological abnormalities are never considered in the evaluation. Aim: We sought to investigate the presence of donor lung pathological abnormalities and determine if these might have an impact on the post lung transplant outcome. Methods: Retrospective analysis of 102 consecutive lung allograft pathology reports of transplanted lungs undergone downsizing by non-anatomical lung resections at the time of transplant. Survival, chronic lung allograft dysfunction (CLAD) development, bronchoalveolar infection and acute rejection were assessed. Statistical analysis was performed using GraphPad Prism. Results: Pathological findings were reported in 64% (65/102) of donor lungs: 22/65 (34%) had bronchial abnormalities (bronchiolitis, inflammation, broncho-pneumonia or granulomas); 38/65 (58%) had alveolar abnormalities (emphysema); 15/65 (23%) showed vascular abnormalities (single or multiple thromboemboli); 9/65 (14%) had multiple abnormalities. The non-adjusted Kaplan-Meyer survival curves showed no difference in terms of survival or CLAD development between all groups. No correlations were found with infections rate, acute rejections episodes or best-FEV1 after transplant. Conclusion: Our data revealed a high presence of abnormal pathology in transplanted lungs, especially emphysematous changes. Donor lung pathology doesn’t seem to affect overall survival, presence of CLAD, infections rate, acute rejection rate or lung function after lung transplantation.