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Effect of Donor Age on Outcome of Lung Transplantation Stratified by Recipient Diagnosis

A Nordic Multicenter Study

Auråen, Henrik, MD1,2; Durheim, Michael Thomas, MD1; Dellgren, Göran, MD, PhD3; Hämmäinen, Pekka, MD, PhD4; Larsson, Hillevi, MD5; Geiran, Odd, MD, PhD2,6; Schultz, Hans Henrik Lawaetz, MD, PhD7; Leuckfeld, Inga, MD, PhD1; Iversen, Martin, MD, PhD7; Fiane, Arnt, MD, PhD2,6; Holm, Are Martin, MD, PhD1,2

doi: 10.1097/TP.0000000000002402
Original Clinical Science—General
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Background. Organs from older donors are increasingly used in lung transplantation, and studies have demonstrated that this could be safe in selected recipients. However, which recipient groups that have the largest benefit of older organs are unclear. This multicenter study reviews all bilateral lung transplantations (BLTx) from donors 55 years or older stratified by recipient diagnosis and compares outcomes with transplantations from younger donors.

Methods. All BLTx recipients (excluding retransplantation) at 5 Scandiatransplant centers between 2000 and 2013 were included (n = 913). Recipients were stratified to diagnosis groups including cystic fibrosis (CF), chronic obstructive pulmonary disease (COPD), interstitial lung disease (ILD), and “other.” Intensive care unit (ICU) length of stay (LOS) and survival were assessed.

Results. Overall, there was no difference in survival among patients transplanted from donors 55 years or older compared with younger donors. However, in CF recipients, donor age 55 years or older was associated with inferior survival (P = 0.014), and this remained significant in a multivariate model (hazard ratio, 5.0; 95% confidence interval, 1.8–14.1; P = 0.002). There was no significant effect of donor age on survival in recipients with COPD, ILD, or in the “other” group in multivariate models. Utilization of older donors was associated with increased ICU LOS for recipients with CF and ILD, but not in the COPD or “other” group.

Conclusions. The BLTx recipients with CF had inferior survival and longer ICU LOS when receiving organs from donors 55 years or older. Recipients with COPD, ILD, or in the “other” group did not have inferior survival in multivariate models.

1 Department of Respiratory Medicine, Oslo University Hospital, Rikshospitalet, Norway.

2 Faculty of Medicine, University of Oslo, Norway.

3 Department of Cardiothoracic Surgery and Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden.

4 Department of Cardiothoracic Surgery, Helsinki University Hospital, Finland.

5 Division of Respiratory Medicine and Allergology, Department of Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden.

6 Department of Cardiothoracic Surgery, Oslo University Hospital Rikshospitalet, Norway.

7 Division of Lung Transplantation, Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark.

Received 5 April 2018. Revision received 7 July 2018.

Accepted 1 August 2018.

A.H. received funding from The Norwegian Respiratory Society to conduct this research.

The authors declare no conflicts of interest.

A.H. participated in the research design, writing, performance of research, data analysis. D.M.T. participated in the research design, writing, performance of research, and data analysis. D.G. participated in the writing and performance of the research. H.P. participated in the writing and performance of the research. L.H. participated in the writing and performance of the research. G.O. participated in the writing and performance of the research. L.S.H.H. participated in the writing and performance of research. L.I. participated in the writing and performance of the research. I.M. participated in the writing and performance of the research. F.A.E. participated in the writing and performance of the research. H.A.M. participated in the research design, writing, performance of research, and data analysis.

Correspondence: Henrik Auråen, MD, Department of Respiratory Medicine, Oslo University Hospital, Rikshospitalet, Norway. (henrikauraen@gmail.com).

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