title: The use of lung donors older than 55 years: a review of the United Network of Organ Sharing database.
abstract: BACKGROUND
  Current lung transplantation guidelines stipulate that the ideal donor is aged younger than 55 years, but several institutions have reported that outcomes using donors aged 55 years and older are comparable with those of younger donors.
  
  
  METHODS
  We retrospectively reviewed the United Network for Organ Sharing (UNOS) database to identify all adult lung transplants between 2000 and 2010 in the United States. Patients were stratified by donor age 18 to 34 (reference), 35 to 54, 55 to 64, and ≥ 65 years. Primary outcomes included survival at 30 days and at 1, 3, and 5 years and rates of bronchiolitis obliterans syndrome (BOS). Survival was assessed using the Kaplan-Meier method. Risk factors for mortality were identified by multivariable Cox and logistic regression.
  
  
  RESULTS
  We identified 10,666 recipients with median follow-up of 3 years (range, 0-10 years). Older donors were more likely to have died of cardiovascular or cerebrovascular causes, but there were no differences in recipient diagnosis, lung allocation score, or incidence of BOS as a function of donor age. The use of donors aged 55 to 64 years was not a risk factor for mortality at 1 year (odds ratio, 1.1; p = 0.304) or 3 years (odds ratio, 0.923; p = 0.571) compared with the reference group; however, use of donors aged > 65 years was associated with increased mortality at both time points (odds ratio, 2.8 and 2.4, p < 0.02).
  
  
  CONCLUSIONS
  Outcomes after lung transplantation using donors aged 55 to 64 years were similar to those observed with donors meeting conventional age criteria. Donors aged ≥ 65 years, however, were associated with decreased intermediate-term survival, although there was no increased risk of BOS for this group.
authors.affiliation: Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA.
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Bittle
authors.forename: Pablo G
authors.initials: PG
authors.lastname: Sanchez
authors.forename: Zachary N
authors.initials: ZN
authors.lastname: Kon
authors.forename: A
authors.initials: A
authors.lastname: Claire Watkins
authors.forename: Keshava
authors.initials: K
authors.lastname: Rajagopal
authors.forename: Richard N
authors.initials: RN
authors.lastname: Pierson
authors.forename: James S
authors.initials: JS
authors.lastname: Gammie
authors.forename: Bartley P
authors.initials: BP
authors.lastname: Griffith
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D016208:Databases, Factual; D005260:Female; D006801:Humans; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D009927:Tissue and Organ Procurement / Q000592:standards*; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult
keywords: UNOS; donor age; donor selection; extended donor criteria; guidelines; lung transplantation