MISMATCH
Lung transplantation has evolved as a treatment of last resort for a number
of serious end-stage lung diseases including interstitial fibrosis, pulmonary
hypertension and COPD. We have a number of patients in the practice who have
had lung transplants with varied success. The post-transplant period has many
potential complications requiring aggressive treatment, usually at the lung center
where the transplant was performed.
Most of us understand that immunologic compatibility is needed when
considering the donor and recipient of a transplanted organ. However, a recent
study also indicates that the matching of donors to recipients should include a
consideration of race, when possible. While race mismatch has been shown to
affect outcomes in kidney, heart and liver transplants, the information about
lungs is relatively new.
The information about race and its effect on lung transplantation success,
in part, comes from a study of 19,504 lung transplant recipients. Specifically, it
was found that whites had significantly worse outcomes when receiving lungs
from African American donors. In the overall analysis of this population, African
American and Hispanic recipients had no apparent survival differences when
receiving race mismatched organs. Therefore, the analysis showed that white
recipient/African American donor was the only race mismatch to significantly
affect survival.
The road to and from lung transplantation can be a difficult one. All
transplant centers have informational meetings with potential candidates to not
only screen the patient for appropriateness, but also to explain the many issues
surrounding the post-transplant period.
