1. DiGiulio, Sarah

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For lung transplants, the use of lungs from donors who smoked increases a patient's probability of survival compared with waiting for a donor with a negative smoking history, despite the risk of complications from transplanting these lungs. That is the conclusion of a study from the Cardiothoracic Advisory Group to the NHS Blood and Transplant and the Association of Lung Transplant Physicians, now available online ahead of print in The Lancet (doi:10.1016/S0140-6736(12)60160-3).


Patients were more likely to lose life-years waiting for a lung from a donor with a negative smoking history than lose life-years from the risks associated with accepting the lung from a donor who smoked, the researchers concluded.


"If transplant surgeons avoided smoker lungs completely, they would be doing their waiting-list patients a dis-service but would appear to have great transplant results," the study's lead author, Robert Bonser, MD, FRCP, FRCS, Professor & Consultant in Cardiac Surgery of Queen Elizabeth Hospital, University Hospitals NHS Foundation Trust, said via email.


According to the study, the chance of death after registration on the transplant list was 21 percent lower for patients who received lungs from smokers compared with those who remained on the waiting list during the study period. But, the analysis also showed that transplant patients who received the lungs of smokers were 46 percent more likely to have died three years post-transplant compared with the data for patients who received lungs of non-smokers.


These findings will be used to better counsel UK lung transplant patients of their donor options, he said. "Patients will be told that overall from the date of listing they are more likely to survive if they accept lungs when offered regardless of smoking history-but that when transplanted, if lungs from a donor smoker have been used the subsequent outcome may be less good."


The findings suggest that more of the patients would be alive at three years if they accepted the donor lung of either a smoker or non-smoker, despite the risks associated with transplanting a lung of a smoker, Bonser explained. Patients are more likely to die waiting for a transplant than from complications of receiving a positive-smoking-history organ.


The researchers used data from 2,181 adult lung transplant patients on the UK Transplant Registry, to analyze how using lungs from donors with a positive smoking history affected transplant patient survival rates compared with individuals on waiting lists that excluded donors who smoked. Current UK policy accepts lung donations from individuals with both positive and negative smoking histories, but recipients can choose to remain on the transplant list if offered the lungs from a donor who smoked.