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Eur J Cardiothorac Surg 2003;23:484-487
© 2003 Elsevier Science NL

The predictive value and inter-observer variability of donor chest radiograph interpretation in lung transplantation

^a Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA
^b Department of Medicine, The Johns Hopkins Medical Institutions, Baltimore, MD, USA

Received 4 July 2002; received in revised form 16 December 2002; accepted 7 January 2003.

^* Corresponding author. Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins Medical Institutions, 618 Blalock, 600 N. Wolfe Street, Baltimore, MD, USA. Tel.: +1-410-955-1753; fax: +1-410-955-3809
e-mail: jconte{at}csurg.jhmi.jhu.edu

Objective: Currently the relationship between the evaluation of the donor chest radiograph and the final disposition of potential donor lungs is unknown, yet potential lung donors receive frequent x-rays. We sought to clarify the role donor chest radiographs and donor lung acceptability. Methods: We conducted a retrospective review of 84 potential organ donors. Radiographs were reviewed separately by three thoracic surgeons and three pulmonologists and either accepted or rejected with no other information. Data was analyzed by Kappa statistic to judge inter-observer variance and it was compared to actual outcome to determine predictive value. Results: The Kappa statistics for observer agreement was 0.149 among the surgeons, 0.510 among the pulmonologists, and 0.336 overall, representing slight, moderate and fair agreement respectively. The reviewers' decisions to accept or reject a lung concurred with the actual clinical outcome 64.2% of the time. The positive predictive value of an accept decision was found to be 78.3% and the negative predictive value of a reject decision was 36.3%. Conclusions: This study suggests that evaluation of the donor chest x-ray is a highly subjective process and demonstrated the limited role the radiograph presently holds in the determination of organ suitability.

Key Words: Lung transplant • Donor chest radiograph