Receiving Lungs from Heavy Drinkers May Cause Risks | Loyola Medicine
Monday, January 19, 2015

Lung transplant patients who receive organs from heavy drinkers may be at risk for worse outcomes

MAYWOOD, Il. (Jan. 19, 2015) – Lung transplant patients who receive lungs from heavy drinkers are nearly nine times more likely to experience a life-threatening complication called primary graft dysfunction, a Loyola University Medical Center study has found.

Lungs transplanted from heavy alcohol users also displayed poorer gas-exchange, and transplant recipients spent more time on ventilators, lead author Erin Lowery, MD, and colleagues report in the journal Alcoholism: Clinical and Experimental Research.

The study also found a trend toward poorer survival among patients who received lungs from heavy drinkers.

"Our findings could have implications for recipients of lung transplantation," Dr. Lowery said. “We need to understand the mechanisms that cause this increased risk so that in the future donor lungs can be treated, perhaps prior to transplant, to improve  outcomes.”

Previous studies have found that alcohol abuse increases the risk to drinkers of tuberculosis, pneumonia and a severe form of lung injury called acute respiratory distress syndrome. The new study is the first to explore the impact of heavy alcohol use in lung transplant donors.

The study included 173 lung transplants performed at Loyola. Heavy alcohol use was defined as women who drank more than three drinks per day or seven drinks per week and men who drank more than four drinks per day or 14 drinks per week. To be considered heavy alcohol users, donors also had to show either an abnormal liver biopsy or abnormal alcohol biomarkers.

Nearly 25 percent of the lung donors were heavy alcohol users. This is in line with previous studies that found that 23 percent of heart donors and 21 percent of kidney donors were alcohol dependent.

Researchers found that, after controlling for other risk factors, patients who received lungs from heavy alcohol users were 8.7 times more likely to develop severe primary graft dysfunction (PGD) than patients who received lungs from donors who did not drink.

PGD is a severe form of lung injury that can occur during the first three days after transplant. Many patients die from PGD, while survivors can experience worse long-term lung function and an increased chance of chronic rejection.

Researchers also found that during the first 24 hours after transplant, the ratio of oxygen carried in the blood to oxygen given to the patient (a measure of how well lungs perform gas exchange) was significantly worse in patients who received lungs from heavy alcohol users.

In an accompanying commentary in Alcoholism, David Guidot, MD, of Emory University School of Medicine wrote the Loyola study “raises the question as to whether or not a history of heavy alcohol use by a potential donor should exclude the use of their lungs in transplantation. At a time when there is a critical shortage of lungs available for transplantation, this is obviously a problematic issue. If other studies support the dramatically increased risk of primary graft dysfunction that Lowery and her colleagues have identified then the lung transplant professional community must confront this thorny question.”

Dr. Guidot added that the Loyola study and other studies on the “alcoholic lung” should serve as a “call to action to develop treatments that can mitigate the effects of alcohol abuse on lung function and improve the donor pool.”

Dr. Lowery is an assistant professor in the Division of Pulmonary and Critical Care Medicine of Loyola University Chicago Stritch School of Medicine. Co-authors are Erica Kuhlmann, DO; Erin Mahoney, APN; Daniel Dilling, MD; Stephanie Kliethermes, PhD; and Elizabeth Kovacs, PhD.

The study is titled "Heavy Alcohol Use in Lung Donors Increases the Risk for Primary Graft Dysfunction." It was supported by grants from the National Institutes of Health and the Dr. Ralph and Marian C. Falk Medical Research Trust.

About Loyola Medicine and Trinity Health

Loyola Medicine, a member of Trinity Health, is a quaternary care system based in the western suburbs of Chicago that includes Loyola University Medical Center (LUMC), Gottlieb Memorial Hospital, MacNeal Hospital and convenient locations offering primary and specialty care services from 1,877 physicians throughout Cook, Will and DuPage counties. LUMC is a 547-licensed-bed hospital in Maywood that includes the William G. and Mary A. Ryan Center for Heart & Vascular Medicine, the Cardinal Bernardin Cancer Center, a Level 1 trauma center, Illinois's largest burn center, a certified comprehensive stroke center and a children’s hospital. Having delivered compassionate care for over 50 years, Loyola also trains the next generation of caregivers through its teaching affiliation with Loyola University Chicago’s Stritch School of Medicine and Marcella Niehoff School of Nursing. Gottlieb is a 247-licensed-bed community hospital in Melrose Park with 150 physician offices, an adult day care program, the Gottlieb Center for Fitness, the Loyola Center for Metabolic Surgery and Bariatric Care and the Loyola Cancer Care & Research at the Marjorie G. Weinberg Cancer Center at Melrose Park. MacNeal Hospital is a 374-bed teaching hospital in Berwyn with advanced inpatient and outpatient medical, surgical and psychiatric services, advanced diagnostics and treatments. MacNeal has a 12-bed acute rehabilitation unit, a 25-bed inpatient skilled nursing facility, and a 68-bed behavioral health program and community clinics. MacNeal has provided quality, patient-centered care to the near west suburbs since 1919.

Trinity Health is one of the largest multi-institutional Catholic healthcare systems in the nation, serving diverse communities that include more than 30 million people across 22 states. Trinity Health includes 94 hospitals, as well as 109 continuing care locations that include PACE programs, senior living facilities and home care and hospice services. Its continuing care programs provide nearly 2.5 million visits annually. Based in Livonia, Mich., and with annual operating revenues of $18.3 billion and assets of $26.2 billion, the organization returns $1.1 billion to its communities annually in the form of charity care and other community benefit programs. Trinity employs about 133,000 colleagues, including 7,800 employed physicians and clinicians. Committed to those who are poor and underserved in its communities, Trinity is known for its focus on the country's aging population. As a single, unified ministry, the organization is the innovator of Senior Emergency Departments, the largest not-for-profit provider of home health care services—ranked by number of visits—in the nation, as well as the nation’s leading provider of PACE (Program of All Inclusive Care for the Elderly) based on the number of available programs.