The Implications of Pulmonary Embolism in a Multiorgan Donor for Subsequent Pulmonary, Renal, and Cardiac Transplantation

Background: Unexpected donor pulmonary embolism is suggested to be associated with primary graft dysfunction (PGD) after lung transplantation. In multiorgan donors with pulmonary embolism, multiple organs could potentially be at high risk for the development of post-transplant PGD. This study investigated (1) the association of donor pulmonary embolism with different organ transplant outcomes where a recipient received an organ (heart or kidney) from a lung donor, (2) the effect of different composition of pulmonary embolism (fat or thromboemboli) on multiorgan post-transplant PGD, and (3) the effect of removal of pulmonary embolism (therapeutic flush) on lung transplant outcomes. Methods: The study included 130 multiorgan donors and 135 lung, 38 heart, and 172 kidney transplant recipients. Results: Pulmonary embolism was detected in 40 of 130 (31%) multiorgan donors (10 fat emboli, 30 thromboemboli). A significant association between donor pulmonary embolism and PGD was seen in lung, but not in heart and kidney transplant recipients. A multivariate analysis showed that lung transplant recipients receiving lungs with fat emboli and thromboemboli were 20.6-fold ( p = 0.0002) and 4.8-fold (p = 0.02) more likely to develop severe PGD, respectively, compared with those who received lungs without pulmonary embolism. Removal of pulmonary embolism reduced the incidence of PGD ( p = 0.01) in lung transplantation. Conclusions: The deleterious effect of donor pulmonary embolism seems to be a local phenomenon, limited to the lung; therefore, the heart and kidneys can be safely used even from a donor with pulmonary embolism. When pulmonary embolism (especially fat emboli) is diagnosed, the likely effect on lung transplant clinical outcomes and the impact of further interventional strategies (therapeutic flush) must be considered.