TUESDAY, May 29 (HealthDay News) -- Should the lungs of smokers
be included in lung transplants? A new study suggests their
inclusion may be warranted.
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.
More information
The U.S. National Heart, Lung, and Blood Institute has more
about
lung transplantation.