title: 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 8860 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 (PGD). The rate of 1-year graft failure was similar among recipients of lungs from donors age 18-64 years, but severely ill recipients (Lung Allocation Score [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 [HR] 1.23, 95% CI 1.01-1.50 and adjusted HR 2.15, 95% CI 1.47-3.15, respectively). Donor age was not associated with the risk of PGD. In summary, the use of lungs from donors age 56 to 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.
authors.affiliation: Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University, New York, NY.
authors.forename: M R
authors.initials: MR
authors.lastname: Baldwin
authors.forename: E R
authors.initials: ER
authors.lastname: Peterson
authors.forename: I
authors.initials: I
authors.lastname: Easthausen
authors.forename: I
authors.initials: I
authors.lastname: Quintanilla
authors.forename: E
authors.initials: E
authors.lastname: Colago
authors.forename: J R
authors.initials: JR
authors.lastname: Sonett
authors.forename: F
authors.initials: F
authors.lastname: D'Ovidio
authors.forename: J
authors.initials: J
authors.lastname: Costa
authors.forename: J M
authors.initials: JM
authors.lastname: Diamond
authors.forename: J D
authors.initials: JD
authors.lastname: Christie
authors.forename: S M
authors.initials: SM
authors.lastname: Arcasoy
authors.forename: D J
authors.initials: DJ
authors.lastname: Lederer
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D006085:Graft Survival; D006801:Humans; D008171:Lung Diseases / Q000401:mortality / Q000601:surgery*; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D055031:Primary Graft Dysfunction / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D055815:Young Adult
keywords: Age; graft failure; lung transplantation; primary graft dysfunction; prognosis
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