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Increasing donor sequence number is not associated with inferior outcomes in lung transplantation
Author(s) -
Axtell Andrea L.,
Moonsamy Philicia,
Melnitchouk Serguei,
Tolis George,
D'Alessandro David A.,
Villavicencio Mauricio A.
Publication year - 2020
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/jocs.14343
Subject(s) - medicine , lung transplantation , sequence (biology) , transplantation , genetics , biology
Background Donor sequence number (DSN) represents the number of recipients to whom an organ has been offered. The impact of seeing numerous prior refusals may potentially influence the decision to accept an organ. We sought to determine if DSN was associated with inferior posttransplant outcomes. Methods Using the United Network for Organ Sharing database, a retrospective analysis was performed on 22 361 patients who received a lung transplant between 2005 and 2017. Patients were grouped into low DSN (1‐24, n = 16 860) and high DSN (>24, n = 5501) categories. Baseline characteristics and posttransplant outcomes were analyzed. An institutional subgroup was also analyzed to compare rates of primary graft dysfunction (PGD) posttransplant. Results The DSN ranged from 1 to 1735 (median, 7; interquartile range, 2‐24). A total of 18 507 recipients received an organ with at least one prior refusal. Recipients of donors with a higher DSN were older (58 vs 55 years; P < .01) but had lower lung allocation scores (43.5 vs 47.5; P < .01). On adjusted analysis, high DSN was not associated with increased mortality (hazard ratio, 0.99; 95% confidence interval, 0.94‐1.04; P = .77). There was no difference in the incidence of graft failure ( P = .37) or retransplantation ( P = .24). Recipient subgroups who received donors with an increasing DSN >50 and >75 also demonstrated no difference in mortality when compared with a low DSN ( P = .86 and P = .97). There was no difference in PGD for patients with a low vs a high DSN at any time posttransplant. Conclusions DSN is not associated with increased mortality in patients undergoing lung transplantation and should not negatively influence the decision to accept a lung for transplant.