Does donor arterial partial pressure of oxygen affect outcomes after lung transplantation? A review of more than 12,000 lung transplants

Introduction In lung transplantation (LTx), the arterial partial pressure of oxygen (PaO 2 ) is traditionally regarded as critical information for assessment of donor lung function. Each center sets its own thresholds; by convention, a donor PaO 2 of less than 300 mm Hg has been considered disqualifying. Limited literature exists to support such a practice. We analyzed all LTxs performed in the United States over a 9-year period to assess the effect of donor PaO 2 on graft survival. Methods The United Network for Organ Sharing (UNOS) database was queried for LTx (January 2000–November 2009). Of 12,545 LTx performed, 12,045 (96%) had donor PaO 2 data on a fraction of inspired oxygen of 1.0, recorded at the time of procurement. Results Mean donor PaO 2 was 407 ± 140 mm Hg. The majority of LTxs had a donor PaO 2 greater than 300 mm Hg (9593 (80%]) whereas PaO 2 was 200 mm Hg or less in 1830 (15%) and 201 to 300 in 582 (5%) donors. Use of donors with a PaO 2 of less than 200 increased over time from 5% (45) in 2000 to 21% (295) in 2009 ( P  = .002). Kaplan-Meier survival analysis showed no difference in graft survival with differing donor PaO 2 s, irrespective of whether patients had a single or double LTx. A Cox multivariable analysis of 21 donor characteristics demonstrated that donor PaO 2 had no association with graft survival. Conclusions Donor PaO 2 levels did not affect graft survival. The use of donors with lower PaO 2 s could substantially increase the donor pool. We are not suggesting that donor PaO 2 is not important when assessing potential lung donors but its level of importance in regard to other criteria appears less than previously believed.