Lung transplantation with lungs from older donors: recipient and surgical factors affect outcomes.
BACKGROUND
A shortage of donors has compelled the use of extended-criteria donor organs in lung transplantation. The purpose of this study was to evaluate the impact of using older donors on outcomes after lung transplantation using current protocols.


METHODS
From January 2003 to August 2009, 593 lung transplants were performed at our institution. We compared 87 patients (14.7%) who received lungs from donors aged 55 years or older with 506 patients who received lungs from donors less than 55 years old. We also examined risk factors for mortality in recipients of lungs from older donors.


RESULTS
The incidence of major complications including severe primary graft dysfunction and early mortality rates were similar between the groups. However, posttransplant peak FEV1 was lower in the patients who received lungs from older donors (71.7% vs. 80.7%, P<0.05). In multivariate analysis, recipient pulmonary hypertension (transpulmonary pressure gradient >20 mm Hg) and prolonged intraoperative cardiopulmonary bypass were significant risk factors for mortality in the recipients of lungs from older donors.


CONCLUSIONS
This large, single-center experience demonstrated that transplanting lungs from donors older than 55 years did not yield worse short- or long-term outcomes as compared with transplanting lungs from younger donors. However, transplanting lungs from older donors into recipients with pulmonary hypertension or recipients who required prolonged cardiopulmonary bypass increased the risk for mortality. Although lungs from older donors should not be excluded because of donor age alone, surgeons should carefully consider their patient selection criteria and surgical plans when transplanting lungs from older donors.
1 Department of Cardiothoracic Surgery and 2 Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA. 3 Address correspondence to: Norihisa Shigemura, M.D., Ph.D., UPMC Presbyterian, Suite C-900, 200 Lothrop Street, Pittsburgh, PA 15213.
Norihisa
N
Shigemura
Tetsuya
T
Horai
Jay K
JK
Bhama
Jonathan
J
D'Cunha
Diana
D
Zaldonis
Yoshiya
Y
Toyoda
Joseph M
JM
Pilewski
James D
JD
Luketich
Christian A
CA
Bermudez
D000328:Adult; D000367:Age Factors; D000368:Aged; D002315:Cardiopulmonary Bypass; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D016040:Lung Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D014019:Tissue Donors; D014184:Transplantation, Homologous; D016896:Treatment Outcome