title: Survival and spirometry outcomes after lung transplantation from donors aged 70 years and older.
abstract: BACKGROUND
  Mediocre donation rates and increasing demand for lung transplantation leads transplant centers to consider extended-criteria donor lungs. Arguably, the largest remaining non-utilized lung donor segment is the elderly individual, already considered for visceral organ donation but not thoracic. So far, transplantation of donor lungs aged ≥ 70 years is rarely reported, and recipient outcomes are unknown. Accordingly, we report a single-center series of lung transplantations from donors aged ≥ 70 years and compare outcomes with contemporary lung transplantations from younger donors.
  
  
  METHODS
  All bilateral lung transplantations performed at our center between March 2011 and July 2014 were analyzed, and 2 cohorts were built according to lung donor age.
  
  
  RESULTS
  A total of 440 bilateral lung transplantations were performed from 413 donors aged <70 years, and 27 donors aged ≥70 years. Donor characteristics did not differ in sex, donor time on mechanical ventilation before retrieval, or donor partial pressure of arterial oxygen/fraction of inspired oxygen ratio. Older donors were significantly less often positive for smoking history (43.7% vs 14.8%, p = 0.003) or for abnormal bronchoscopy results (52.9% vs 15.8%, p = 0.002). Recipients receiving donor lungs aged <70 years were younger than those receiving older donor lungs ≥ 70 (49.8 [range, 35-58] vs 58 [range, 53-62] years, p < 0.0001). Underlying diagnoses did not differ significantly between the groups. Post-operative mechanical ventilation times (15 [range, 10-59] vs 27.5 [range, 10-75.8] hours), intensive care unit stays (3 [range, 1-5] vs 3 [range, 1-8] days), and total hospital lengths of stay (24 [range, 22-40.5] vs 24 [range, 22-40] days) of the recipients did not differ significantly between the two groups. The percentage predicted forced expiratory volume in 1 second was 86.5% ± 26.2% 12 months after transplantation of younger lungs vs 72.2% ± 23.8% (p = 0.01) after transplantation of older lungs. Differentiating the spirometry findings according to underlying diseases showed significantly lower forced expiratory volume in 1 second values after transplantation of donor lungs aged ≥70 only in idiopathic pulmonary fibrosis recipients but not in emphysema patients. Patient survival up to 36 months was not significantly different, with 1-year survival being 92.9% for younger vs 95.5% for older donor lungs.
  
  
  CONCLUSIONS
  Use of donor lungs aged ≥70 years for transplantation is safe, without compromising survival. However, spirometry findings after transplantation with donors ≥70 years indicate better functional outcomes in emphysema recipients than in idiopathic pulmonary fibrosis recipients.
authors.affiliation: Departments of a?>Cardiothoracic, Transplant and Vascular Surgery.
authors.forename: Wiebke
authors.initials: W
authors.lastname: Sommer
authors.affiliation: Departments of a?>Cardiothoracic, Transplant and Vascular Surgery.
authors.forename: Fabio
authors.initials: F
authors.lastname: Ius
authors.affiliation: Departments of a?>Cardiothoracic, Transplant and Vascular Surgery.
authors.forename: Jawad
authors.initials: J
authors.lastname: Salman
authors.affiliation: Departments of a?>Cardiothoracic, Transplant and Vascular Surgery.
authors.forename: Murat
authors.initials: M
authors.lastname: Avsar
authors.affiliation: Departments of a?>Cardiothoracic, Transplant and Vascular Surgery.
authors.forename: Igor
authors.initials: I
authors.lastname: Tudorache
authors.affiliation: Departments of a?>Cardiothoracic, Transplant and Vascular Surgery.
authors.forename: Christian
authors.initials: C
authors.lastname: Kühn
authors.affiliation: Departments of a?>Cardiothoracic, Transplant and Vascular Surgery.
authors.forename: Bettina
authors.initials: B
authors.lastname: Wiegmann
authors.affiliation: Departments of a?>Cardiothoracic, Transplant and Vascular Surgery.
authors.forename: Georg
authors.initials: G
authors.lastname: Marsch
authors.affiliation: Departments of a?>Cardiothoracic, Transplant and Vascular Surgery.
authors.forename: Tim
authors.initials: T
authors.lastname: Kaufeld
authors.affiliation: Departments of a?>Cardiothoracic, Transplant and Vascular Surgery.
authors.forename: Norman
authors.initials: N
authors.lastname: Zinne
authors.affiliation: Respiratory Medicine.
authors.forename: Thomas
authors.initials: T
authors.lastname: Fuehner
authors.affiliation: Respiratory Medicine.
authors.forename: Mark
authors.initials: M
authors.lastname: Greer
authors.affiliation: Respiratory Medicine.
authors.forename: Jens
authors.initials: J
authors.lastname: Gottlieb
authors.affiliation: Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany.
authors.forename: Dietmar
authors.initials: D
authors.lastname: Boethig
authors.affiliation: Departments of a?>Cardiothoracic, Transplant and Vascular Surgery.
authors.forename: Axel
authors.initials: A
authors.lastname: Haverich
authors.affiliation: Respiratory Medicine.
authors.forename: Tobias
authors.initials: T
authors.lastname: Welte
authors.affiliation: Departments of a?>Cardiothoracic, Transplant and Vascular Surgery. Electronic address: warnecke.gregor@mh-hannover.de.
authors.forename: Gregor
authors.initials: G
authors.lastname: Warnecke
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D006801:Humans; D008171:Lung Diseases / Q000401:mortality* / Q000503:physiopathology / Q000601:surgery*; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013147:Spirometry; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome
keywords: extended criteria donor; lung transplantation; marginal donor; old donor