Lungs transplanted from smokers are better than no transplant
UK study finds lung transplant patients who receive the lungs of smokers have a better overall chance of survival than those who remain on waiting lists
29th May 2012 - New research shows that lung transplant patients who receive the lungs of smokers have a better overall chance of survival than those who remain on waiting lists, despite the fact that they tend to survive for a shorter period after transplantation than those who receive the lungs of non-smokers.
The study goes on to back the UK's policy of using organs from both smoking and non- smoking donors.
Smokers' lungs better than none
The findings, published in The Lancet, may prove controversial following media reports in recent years describing how some transplant patients have died after receiving smokers' lungs.
In the UK donors with a positive smoking history provide nearly 40% of the lungs available for transplantation, according to the study's lead author Professor Robert Bonser, of the Queen Elizabeth Hospital, Birmingham and University of Birmingham. He said in a press statement: "Our data show that patients awaiting lung transplantation in the UK are likely to survive longer if they are willing to accept lungs from any suitable donor, irrespective of smoking history... Rejection of this donor-organ resource would increase waiting-list mortality and is ill-advised."
Researchers used information from the UK Transplant Registry and Office of National Statistics to examine the survival rates of 2,181 adult UK patients awaiting lung transplants between July 1st 1999 and December 31st 2010. Of 1,295 lung transplants that took place during this period, in around two in five the lungs came from donors with a history of smoking.
Analysis showed that those receiving lungs from smokers were 46% more likely to have died three years after transplantation than those receiving lungs from non-smokers. However, compared to those who remained on the waiting list during the study period, the chance of death after registration was 21% lower for patients who received lungs from smokers.
The authors found that the effects were particularly pronounced for patients suffering from septic lung disease and fibrosis, with septic lung disease patients experiencing a 40% increase in survival and fibrosis patients a 61% increase in survival when the donor pool includes the lungs of smokers rather than excluding them.
It is possible that patients could decline lungs from donors with positive smoking histories and choose to wait for a perfectly matched donor with fewer risk factors in order to increase their chances of post-transplantation survival. However, to be registered on the waiting list, a patient must have advanced, life-threatening lung disease and 34% patients on the UK National Transplant list die waiting for a transplant.
The authors highlight the importance of fully informing patients of the effects of accepting smokers' lungs, pointing out that: "Although lungs from such donors are associated with worse outcomes, the individual probability of survival is greater if they are accepted than if they are declined and the patient chooses to wait for a potential transplant from a donor with a negative smoking history. This situation should be fully explained to and discussed with patients who are accepted for lung transplantation."
Dr Shaf Keshavjee and Dr Marcelo Cypel of the Toronto Lung Transplant Program, University Health Network, Toronto, Ontario, Canada, point out in a comment that in the UK, more than 80% of lungs from brain death and cardiac death multi-organ donors are declined for transplantation, suggesting that research is needed to develop techniques to repair damaged lungs that could be used to boost the donor pool.