Donor Age and Early Graft Failure After Lung Transplantation: A Cohort Study

Abstract

Lungs from older adult organ donors are often unused because of concerns for increased mortality. We examined associations between donor age and transplant outcomes among 8,860 adult lung transplant recipients using Organ Procurement and Transplantation Network and Lung Transplant Outcomes Group data. We used stratified Cox proportional hazard models and generalized linear mixed models to examine associations between donor age and both 1-year graft failure and primary graft dysfunction. The rate of 1-year graft failure was similar among recipients of lungs from donors age 18–64 years, but severely ill recipients (LAS > 47.7 or use of mechanical ventilation) of lungs from donors age 56–64 years had increased rates of 1-year graft failure (p-values for interaction = 0.04 and 0.02, respectively). Recipients of lungs from donors <18 and ≥65 years had increased rates of 1-year graft failure (adjusted hazard ratio 1.23, 95% CI 1.01–1.50 and adjusted hazard ratio 2.15, 95% CI 1.47–3.15, respectively). Donor age was not associated with the risk of primary graft dysfunction. In summary, the use of lungs from donors age 56–64 years may be safe for adult candidates without a high LAS, and the use of lungs from pediatric donors is associated with a small increase in early graft failure.

Survival in Adult Lung Transplant Recipients Receiving Pediatric Versus Adult Donor Allografts

“…In contrast, Baldwin and colleagues [13] reported that adult LTx recipients receiving lungs from donors <18 years of age experienced higher 1-year graft failure rates. The current study could not confirm the findings of either of these two previous studies, with survival in adult LTx recipients not being improved or worsened by receiving lungs from donors younger than 18 years of age.…”

“…In adult LTx, donor age is a recognized factor regarding potential effects on clinical outcomes [13][14][15][16][17][18][19]. The majority of the current medical literature has primarily addressed the influences of older donor lungs, but few studies have assessed the impact of younger donor organs.…”

“…The majority of published work regarding the effects of donor age has centered on older donor lungs, which have been shown to adversely influence outcomes after LTx [13,14]. Baldwin and colleagues [13] reported that recipients of lungs from donors 65 years old and older had increased rates of 1-year graft failure, and recent work [14] by our group found that lungs from older donors (50 years of age) were adversely related to survival in younger recipients younger than 60 or younger than 65 years. In pediatric LTx recipients, adult donor lung allografts were not associated with worse survival [15].…”

“…In their work, Baldwin and colleagues [13] reported that recipients of lungs from donors younger than 18 years had increased rates of 1-year graft failure (adjusted hazard ratio [HR] ¼ 1.23; 95% confidence interval [CI] ¼ 1.01% to 1.50%). To date, no study has investigated whether pediatric donor lungs affect survival in adult recipients.…”

Update in Lung Transplantation 2013

“…The magnitude of the association between graft failure and donor age 50 to 64 years was small; however, this effect was of most notable impact when differing recipient characteristics were considered, such as higher lung allocation score (LAS) or need for mechanical ventilation bridge to transplant. In contrast, recipients of lungs from donors aged 65 years or older had a more than twofold increased rate of 1-year graft failure (hazard ratio, 2.15; 95% CI, 1.47-3.15) when accounting for relevant recipient, donor, and procedure characteristics (13).…”