Donor Substance Abuse is Not Associated with Late High-Grade Primary Graft Dysfunction (PGD) in Lung Transplant

Purpose The donor pool for lung transplantation (LT) may be expanded by procuring from donors with substance abuse (SA) history. Scant data exists on the early course of recipients of these lungs. We assessed the association between donor SA and perioperative outcomes. Methods We reviewed LTs at our center from Jan. 2014-Jan. 2019 and donor data from the United Network for Organ Sharing. SA was defined as reported use of illicit substances (cannabis, cocaine, amphetamines, opioids)/tobacco 1+ times/month or positive post-mortem screen, or consumption of 2+ alcoholic drinks/day. The primary outcome was late high-grade PGD due to its risk for chronic lung allograft dysfunction (CLAD). Late high-grade PGD was defined as PGD 2-3 at 48-72 hours. Secondary outcomes were ventilator hours (VH), initial intensive care unit (ICU) hours, initial hospital length of stay (LOS), 30-day mortality, and first year FEV1% predicted trends. Results 350 LT patients were included in this study. 198/350 (57%) patients received SA donor lungs, while 152/350 (43%) patients received non-SA donor lungs. 82/198 (42%) in the SA donor group developed late high-grade PGD vs. 61/152 (42%) in the non-SA donor group. On multivariable logistic regression (Figure 1), late high-grade PGD was not associated with donor SA (OR 1.11, 95% CI 0.67-1.85, p=0.687). Bivariate comparison found no association between donor SA and VH, ICU hours, and LOS. 30-day survival was 98.99% (n=196) in the SA donor group vs. 98.68% (n=150) in the non-SA donor group. The log rank test detected no difference in 30-day survival between the groups (p=0.789). An estimating equation model and analysis found no evidence that donor SA had an effect on FEV1% predicted over time (p=0.907). Conclusion Donor SA does not impact risk for late high-grade PGD, perioperative outcomes, 30-day survival, or first-year FEV1% predicted. Lungs from donors with history of SA may be considered for use in transplant to help reduce waitlist mortality.