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Use of Smokers' Lungs for Transplant Has Pros, Cons
Study finds tapping such organs is better than leaving patients on waiting list, but there is a downside
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Tuesday, May 29, 2012
The study found that lung transplant patients who receive smokers' lungs still are more likely to survive than those who refuse such lungs and remain on the transplant waiting list.
The lives of patients who receive smokers' lungs, however, tended to be shorter than those who receive the lungs of non-smokers, the British researchers added. Given the evidence, however, Britain's policy of using smokers' lungs for transplant should be continued, according to the authors of the study published online May 28 in The Lancet.
The issue is not just a British one -- speaking to the Associated Press, Dr. Normam Edelman, chief medical officer for the American Lung Association, said smokers' lungs are also used for transplant in the United States, although he did not have data on how common the practice might be.
But the bottom line from the new study is that "patients awaiting lung transplantation in the U.K. are likely to survive longer if they are willing to accept lungs from any suitable donor, irrespective of smoking history," lead author Dr. Robert Bonser, of the Queen Elizabeth Hospital in Birmingham and the University of Birmingham, said in a journal news release. "Donors with a positive smoking history provide nearly 40 percent of the lungs available for transplantation [in the U.K.] Rejection of this donor-organ resource would increase waiting-list mortality and is ill-advised."
Bonser and his colleagues examined the survival rates for nearly 2,200 adult patients in the United Kingdom awaiting lung transplants between 1999 and 2010. Of the nearly 1,300 lung transplants that took place during that time, about two in every five came from donors with a history of smoking.
Patients who received smokers' lungs were 46 percent more likely to have died three years after transplantation than those who received lungs from non-smokers. However, patients who received smokers' lungs also were 21 percent less likely to die than those who remained on the waiting list.
The researchers also found that including smokers' lungs in the donor pool increased the likelihood of survival by 61 percent for patients with fibrosis and by 40 percent for those with septic lung disease.
"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," the authors wrote. "This situation should be fully explained to and discussed with patients who are accepted for lung transplantation."
One expert in the United States said the study "raises a few issues."
Dr. Len Horovitz, pulmonary specialist at Lenox Hill Hospital in New York City, said that "because many patients may die awaiting transplant, one might argue that a lung damaged by smoking (not severely) would be better than no functioning lung at all. But lungs of smokers may be mild or moderately damaged (COPD), and also carry the risk of lung cancer, especially with post operative chronic use of immune suppressors. Nevertheless, in a dying patient, the prolongation of life -- however long that may be -- [and] the benefit is clear."
Although these findings have clear implications for the United Kingdom, it "is important to realize that the relation between risk of dying on the waiting list and the benefit of accepting a transplant from a donor with a substantial smoking history can vary by country and center," Dr. Shaf Keshavjee and Dr. Marcelo Cypel of the Toronto Lung Transplant Program of the University Health Network in Canada, wrote in an accompanying commentary in the journal.
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