Skip to main navigation menu Skip to main content Skip to site footer

Original article

Vol. 148 No. 1718 (2018)

Extended-criteria donors in lung transplantation in Switzerland: an evaluation of two adapted lung donor scores

  • Andreas Elmer
  • Matthias Birrer
  • Julius Weiss
  • John-David Aubert
  • Christian Benden
  • Ilhan Inci
  • Thorsten Krueger
  • Paola M. Soccal
  • Franz F. Immer
DOI
https://doi.org/10.57187/smw.2018.14614
Cite this as:
Swiss Med Wkly. 2018;148:w14614
Published
24.04.2018

Summary

AIM

Various scoring systems aim to assess the quality of organs donated for transplantation on the basis of patient characteristics, clinical examination and laboratory results. How well such scoring systems reflect the practice in lung transplantation in Switzerland has never been studied. Therefore, we evaluated two scoring systems for their ability to predict whether or not donor lungs are accepted by the two Swiss lung transplant centres.

METHODS

We retrospectively analysed patient data of adult deceased organ donors in Switzerland between 1 July 2007 and 30 June 2014. Included were all donors from whom at least one organ was transplanted. We evaluated two lung donor quality scores, the multicentre-developed Eurotransplant donor score (EDS), and the single-centre-developed Zurich donor score (ZDS). Both scores were slightly adapted to be applicable to Swiss deceased organ donor data. We evaluated whether these scores can predict whether lungs were transplanted or refused by Swiss transplant centres, using univariate logistic regression. We further assessed their discriminative power by calculating the area under the receiver operating characteristic curve (AUC).

RESULTS

Of the 635 donors included in our analysis, 295 (46%) were accepted as lung donors by one of the two lung transplant centres in Switzerland. Our analysis showed that both scores can predict whether or not a donor lung is likely to be accepted for transplantation in Switzerland. As the score value of a donor increases, the odds of the lung being transplanted significantly decreases (odds ratio [OR] 0.58, 95% confidence interval [CI] 0.51–0.65 for the adapted EDS; OR 0.35, 95% CI 0.28–0.43 for the adapted ZDS). This effect is slightly more pronounced in the adapted ZDS than in the adapted EDS. The discriminatory power of the scores from the AUC was 0.719 (95% CI 0.680–0.758) for the adapted EDS, and 0.723 (95% CI 0.681–0.760) for the adapted ZDS, which for both was deemed fair discrimination.

CONCLUSIONS

Both scoring systems are able to predict whether or not donor lungs are accepted by the two Swiss lung transplant centres. As an alternative to adapting an established scoring system, a national lung quality score could be derived de novo. This could be based on a logistic regression analysis including the most relevant donor characteristics. However, such a new score would need to be validated on an independent sample and ideally tested for its predictive value in terms of post-transplantation outcome.

References

  1. European Directorate for the Quality of Medicines. Guide to the quality and safety of organs for transplantation. 6th ed. S.l.: COUNCIL OF EUROPE; 2016.
  2. Chaney J, Suzuki Y, Cantu E, 3rd, van Berkel V. Lung donor selection criteria. J Thorac Dis. 2014;6(8):1032–8.
  3. Sommer W, Kühn C, Tudorache I, Avsar M, Gottlieb J, Boethig D, et al. Extended criteria donor lungs and clinical outcome: results of an alternative allocation algorithm. J Heart Lung Transplant. 2013;32(11):1065–72. doi:.https://doi.org/10.1016/j.healun.2013.06.021 DOI: https://doi.org/10.1016/j.healun.2013.06.021
  4. Botha P. Extended donor criteria in lung transplantation. Curr Opin Organ Transplant. 2009;14(2):206–10. doi:.https://doi.org/10.1097/MOT.0b013e328326c834 DOI: https://doi.org/10.1097/MOT.0b013e328326c834
  5. Van Raemdonck D, Neyrinck A, Verleden GM, Dupont L, Coosemans W, Decaluwé H, et al. Lung donor selection and management. Proc Am Thorac Soc. 2009;6(1):28–38. doi:.https://doi.org/10.1513/pats.200808-098GO DOI: https://doi.org/10.1513/pats.200808-098GO
  6. Orens JB, Boehler A, de Perrot M, Estenne M, Glanville AR, Keshavjee S, et al., Pulmonary Council, International Society for Heart and Lung Transplantation. A review of lung transplant donor acceptability criteria. J Heart Lung Transplant. 2003;22(11):1183–200. doi:.https://doi.org/10.1016/S1053-2498(03)00096-2 DOI: https://doi.org/10.1016/S1053-2498(03)00096-2
  7. Smits JM, van der Bij W, Van Raemdonck D, de Vries E, Rahmel A, Laufer G, et al. Defining an extended criteria donor lung: an empirical approach based on the Eurotransplant experience. Transpl Int. 2011;24(4):393–400. doi:.https://doi.org/10.1111/j.1432-2277.2010.01207.x DOI: https://doi.org/10.1111/j.1432-2277.2010.01207.x
  8. Inci I, Ehrsam J, Hillinger S, Opitz I, Schneiter D, Benden C, et al. The impact of donor comorbidities in predicting long-term survival in lung transplantation: the Zurich Donor Score. Interact Cardiovasc Thorac Surg. 2015;21(suppl1):S35. doi:.https://doi.org/10.1093/icvts/ivv204.126 DOI: https://doi.org/10.1093/icvts/ivv204.126
  9. Oto T, Levvey BJ, Whitford H, Griffiths AP, Kotsimbos T, Williams TJ, et al. Feasibility and utility of a lung donor score: correlation with early post-transplant outcomes. Ann Thorac Surg. 2007;83(1):257–63. doi:.https://doi.org/10.1016/j.athoracsur.2006.07.040 DOI: https://doi.org/10.1016/j.athoracsur.2006.07.040
  10. Swets JA. Measuring the accuracy of diagnostic systems. Science. 1988;240(4857):1285–93. doi:.https://doi.org/10.1126/science.3287615 DOI: https://doi.org/10.1126/science.3287615
  11. R Core Team. R: A language and environment for statistical computing. [Internet]. Vienna, Austria: R Foundation for Statistical Computing; 2017. Available from: https://www.R-project.org/
  12. Council of Europe. International figures on donation and transplantation 2014. Newsl Transpl [Internet]. 2015 [cited 2016 Jul 28];20. Available from: https://www.edqm.eu/sites/default/files/newsletter_transplant_2015.pdf
  13. Somers J, Ruttens D, Verleden SE, Cox B, Stanzi A, Vandermeulen E, et al. A decade of extended-criteria lung donors in a single center: was it justified? Transpl Int. 2015;28(2):170–9. doi:.https://doi.org/10.1111/tri.12470 DOI: https://doi.org/10.1111/tri.12470
  14. Weiss J, Elmer A, Mahíllo B, Avsec D, Cozzi E, Haase-Kromwijk BJJM, et al. Evolution of deceased organ donation activity vs. efficiency over a 15 year period: an international comparison. TPA-2017-1604R1 [Preprint, revised 2018 Feb 1]. DOI: https://doi.org/10.1097/TP.0000000000002226
  15. ISHLT. Characteristics for transplants performed between january 1, 2015 and december 31, 2016 [Internet]. ISHLT Transplant Registry Quarterly Reports for Lung in Europe. 2017 [cited 2017 Aug 29]. Available from: https://www.ishlt.org/registries/quarterlyDataReportResults.asp?organ=LU&rptType=donor_demo&continent=3
  16. OPTN. Deceased donors recovered in the U.S. by donor age [Internet]. Organ Procurement and Transplantation Network. 2017 [cited 2017 Aug 29]. Available from: https://optn.transplant.hrsa.gov/data/view-data-reports/national-data/
  17. Valapour M, Skeans MA, Smith JM, Edwards LB, Cherikh WS, Callahan ER, et al. OPTN/SRTR annual data report 2014: lung. Am J Transplant. 2016;16(S2, Suppl 2):141–68. doi:.https://doi.org/10.1111/ajt.13671 DOI: https://doi.org/10.1111/ajt.13671
  18. Koller MT, Stampf S, Rick J, Bianco S, Branca S, Achermann R, et al. Swiss Transplant Cohort Study report (May 2008 - December 2015) [Internet]. Basel; 2016 Aug [cited 2016 Nov 1] p. 76. (STCS Report). Available from: http://www.stcs.ch/internal/reports/stcs_annualreport_august_2016_final.pdf
  19. ISHLT. Survival rates for transplants performed between july 1, 2012 and june 30, 2016 [Internet]. ISHLT Transplant Registry Quarterly Reports for Lung in Europe. 2017 [cited 2017 Aug 29]. Available from: https://www.ishlt.org/registries/quarterlyDataReportResults.asp?organ=LU&rptType=tx_p_surv&continent=3

Most read articles by the same author(s)

1 2 > >>