Lung transplantation from polytrauma donors: beyond primary graft dysfunction

Background Lung donors are increasingly older and marginal. Polytrauma donors (PD) represent a potentially valuable resource due to their younger age, although trauma-related lung injury raises concerns regarding graft quality. This study aimed to evaluate early and mid-term outcomes after lung transplantation using lungs from PDs compared with non-polytrauma donors (NPD). Methods We retrospectively analyzed 125 lung transplant recipients from brain-dead donors between January 2013 and June 2024. Perioperative outcomes, primary graft dysfunction (PGD), and pulmonary function at 1, 3, and 6 months were compared between PD ( n = 36) and NPD ( n = 89) groups. To account for baseline differences, a 1:1 propensity score matching (PSM) was performed based on donor age, recipient age, and ischemic time. Results In the overall cohort, PDs were younger and more frequently male, with a higher prevalence of pulmonary contusions. Early postoperative outcomes, including PGD, ICU stay, and perioperative complications, were comparable between groups. At 6 months, overall survival was higher in the PD group (91.7 vs. 75.3%, p = 0.048). After PSM, no significant differences were observed in survival ( p = 0.66), perioperative outcomes, or pulmonary function. Functional recovery and CLAD rates were similar between groups across all time points. Conclusions Lung transplantation using grafts from polytrauma donors is not associated with worse perioperative or mid-term outcomes. After adjustment for baseline differences, outcomes were comparable to those from non-polytrauma donors, supporting the safe and selective use of these grafts as a strategy to expand the donor pool.