Division of Thoracic Surgery, Medical University of Vienna, Vienna, Austria.
Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria.
J Heart Lung Transplant. 2021 Jan;40(1):33-41. doi: 10.1016/j.healun.2020.10.008. Epub 2020 Oct 28.
The evaluation of donor lungs heavily depends on the subjective judgment of the retrieval surgeon. As a consequence, acceptance rates vary significantly among transplant centers. We aimed to determine donor ventilation parameters in a prospective study and test if they could be used as objective quality criteria during organ retrieval.
A prospective evaluation of lung donors was performed in 3 transplant centers. Ventilation parameters were collected at the time of retrieval using a standardized ventilation protocol. Recipient length of mechanical ventilation (LMV) was defined as the primary end point, and collected data was used to build linear models predicting LMV.
In total, 166 donors were included in this study. Median LMV after transplantation was 32 hours (interquartile range: 20-63 hours). Peak inspiratory pressure and dynamic compliance (C) at the time of retrieval, but not the partial pressure of oxygen/fraction of inspired oxygen (P/F) ratio, correlated with recipient LMV in Spearman correlations (r = 0.280, p = 0.002; r = -0.245, p = 0.003; and r = 0.064, p = 0.432, respectively). Linear models were built to further evaluate the impact of donor ventilation parameters on LMV. The first model was based on donor P/F ratio, donor age, donor intubation time, donor smoking history, donor partial pressure of carbon dioxide, aspiration, chest trauma, and pathologic chest X-ray. This model performed poorly (multiple R-squared = 0.063). In a second model, donor ventilation parameters were included, and C was identified as the strongest predictor for LMV. The third model was extended by recipient factors, which significantly improved the robustness of the model (multiple R-squared = 0.293).
In this prospective evaluation of donor lung parameters, currently used donor quality criteria poorly predicted recipient LMV. Our data suggest that C is a strong donor-bound parameter to predict short-term graft performance; however, recipient factors are similarly relevant.
供体肺的评估严重依赖于获取外科医生的主观判断。因此，接受率在不同移植中心之间差异很大。我们旨在前瞻性研究中确定供体通气参数，并测试它们是否可作为器官获取期间的客观质量标准。
在 3 个移植中心进行前瞻性评估。使用标准化通气方案在获取时收集通气参数。受体机械通气时间（LMV）定义为主要终点，并收集数据以构建预测 LMV 的线性模型。
本研究共纳入 166 例供体。移植后受体 LMV 的中位数为 32 小时（四分位间距：20-63 小时）。在 Spearman 相关性分析中，获取时的吸气峰压和动态顺应性（C），而不是氧分压/吸入氧分数比（P/F）与受体 LMV 相关（r=0.280，p=0.002；r=-0.245，p=0.003；r=0.064，p=0.432）。建立线性模型以进一步评估供体通气参数对 LMV 的影响。第一个模型基于供体 P/F 比、供体年龄、供体插管时间、供体吸烟史、供体二氧化碳分压、误吸、胸部外伤和胸部病理 X 线。该模型性能较差（多元 R 平方=0.063）。在第二个模型中，纳入了供体通气参数，C 被确定为 LMV 的最强预测因子。第三个模型扩展到受体因素，这显著提高了模型的稳健性（多元 R 平方=0.293）。
在供体肺参数的这项前瞻性评估中，目前使用的供体质量标准对受体 LMV 的预测能力较差。我们的数据表明，C 是预测短期移植物功能的强有力供体相关参数；然而，受体因素同样重要。
