Lung transplantation with lungs from donors fifty years of age and older.
BACKGROUND
A shortage of donors has led to the progressive expansion of criteria for donor selection in lung transplantation. The outcome of recipients of lungs from donors aged 50 years or older is analyzed systematically.


METHODS
From March 1998 to June 2003, 49 recipients received lungs from donors aged 50 years or older (range 50-64 years, mean 54 +/- 3 years). This group of recipients was compared with 244 patients receiving lungs from donors aged less than 50 years (range 7-49 years, mean 32 +/- 11 years). This study was undertaken on all 293 patients at our institution who received Perfadex-preserved lungs (Vitrolife, Goteborg, Sweden).


RESULTS
Recipient age, sex, and indications for transplant did not differ significantly between groups. Also, the percentage of the different types of transplants (bilateral or single lung transplantation) performed was equal in both cohorts. Donor Pa(O2) /F(IO2) ratios before lung retrieval (415 +/- 91 vs 439 +/- 113, respectively) and length of ischemic time (347 +/- 67 minutes vs 351 +/- 84 minutes, respectively) did not differ significantly between the older and younger donor groups. The following posttransplant parameters were also not statistically different: first Pa(O2)/F(IO2) at intensive care unit arrival (274 +/- 125 in the older donor group vs 253 +/- 119 in the younger donor group, respectively), mechanical ventilation time (328 +/- 427 hours vs 269 +/- 425 hours, respectively), and length of stay in the intensive care unit (16 +/- 18 days vs 14 +/- 18 days, respectively). Recipient survival in the older and younger donor groups at 30 days, 3, 6, 12, 24, and 60 months was 77% +/- 6%, 75% +/- 6%, 73% +/- 7%, 73% +/- 7%, 68% +/- 5%, and 68% +/- 4% versus 86% +/- 2%, 83% +/- 3%, 80% +/- 3%, 78% +/- 3%, 71% +/- 4%, and 66% +/- 4%, respectively.


CONCLUSIONS
Lung grafts from elderly donors have been considered as marginal organs for transplantation. However, this study indicates that transplantation of lungs from carefully selected donors aged 50 years or more may lead to similar short- and long-term outcomes compared with lungs from younger donors. The use of lungs from elderly donors may help to increase the number of donor organs in lung transplantation.
Fischer
Stefan
S
Hannover Thoracic Transplant Program, Division of Thoracic- and Cardiovascular Surgery, Hannover Medical School, Hannover, Germany.
Gohrbandt
Bernhard
B
Struckmeier
Pascal
P
Niedermeyer
Jost
J
Simon
Andre
A
Hagl
Christian
C
Kallenbach
Klaus
K
Haverich
Axel
A
Strüber
Martin
M
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002648:Child; D015331:Cohort Studies; D003422:Critical Care; D046148:Donor Selection; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D006801:Humans; D007902:Length of Stay; D008168:Lung / Q000502:physiology; D016040:Lung Transplantation / Q000379:methods* / Q000502:physiology; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption / Q000502:physiology; D012121:Respiration, Artificial; D012737:Sex Factors; D015996:Survival Rate; D013997:Time Factors; D014019:Tissue Donors; D016896:Treatment Outcome