Lung transplantation using donors 55 years and older: is it safe or just a way out of organ shortage?
OBJECTIVE
Lung organ scarcity has led to more generous acceptance of organs under the idea of extended-donor criteria. However, long-term effects have to be monitored to redefine present practice. In this study, we investigated the impact of donor age over 55 years in lung transplantation.


METHODS
In this retrospective study, 186 consecutive double-lung transplantation procedures from January 2000 to December 2008 were evaluated. A total of 19 recipients received lungs from donors aged 55 years or older (range 55-69 years) (group A) and 167 received lungs from younger donors (range 8-54) (group B). In-hospital mortality, intensive care unit (ICU) stay, rejection episodes, lung function and survival up to 5 years were evaluated.


RESULTS
In-hospital mortality was similar in both groups (group A: 10.5%; group B: 13.7%). Postoperative ICU stay was 19+/-33 days versus 17+/-34 days (A vs B). Rejection episodes as well as postoperative lung function up to 5 years, and overall cumulative 5-year survival (group A: 52.4%; group B: 50.9%) did not reach statistical significance. However, a trend of increased bronchiolitis obliterans syndrome (BOS) prevalence and reduced lung function was noted. Cause of death showed no differences in both groups.


CONCLUSIONS
Donor age > or =55 years does not compromise immediate and long-term results after lung transplantation, although long-term observation of patients receiving such an organ suggests earlier lung dysfunction. Due to the rising need of organs, lungs from donors aged 55 or older have to be considered for transplantation. However, the acceptance should be based on donor lung evaluation and individual recipient needs. Long-term outcomes over 5 years need to be further investigated.
Pizanis
Nikolaus
N
Department of Thoracic and Cardiovascular Surgery, West German Heart Center Essen, University Hospital of Essen, Hufelandstr 55, 45122 Essen, Germany. Nikolaus.Pizanis@uk-essen.de
Heckmann
Jens
J
Tsagakis
Konstantinos
K
Tossios
Paschalis
P
Massoudy
Parwis
P
Wendt
Daniel
D
Jakob
Heinz
H
Kamler
Markus
M
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002648:Child; D046148:Donor Selection / Q000379:methods*; D004812:Epidemiologic Methods; D005260:Female; D005541:Forced Expiratory Volume; D006084:Graft Rejection; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay / Q000706:statistics & numerical data; D016040:Lung Transplantation / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D010313:Partial Pressure; D011182:Postoperative Care / Q000379:methods; D013147:Spirometry; D014019:Tissue Donors; D055815:Young Adult
D010100:Oxygen