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EFFECT OF DONOR AGE ON OUTCOME OF LUNG TRANSPLANTATION STRATIFIED BY RECIPIENT DIAGNOSIS

A NORDIC MULTICENTER STUDY

Auråen, H1,2; Durheim, MT1; Dellgren, G3; Hämmäinen, P4; Larsson, H5; Geiran, O2,6; Lawaetz Schultz, HH7; Leuckfeld, I1; Iversen, M7; Fiane, AE2,6; Holm, AM1,2

doi: 10.1097/TP.0000000000002402
Original Clinical Science—General: PDF Only
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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 stratified by recipient diagnosis, and compares outcomes with transplantations from younger donors.

Methods All BLTx recipients (excluding ReTx) 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 compared to younger donors. However, in CF-recipients, donor age ≥55 years was associated with inferior survival (p=0.014), and this remained significant in a multivariate model (HR 5.0, CI 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 BLTx recipients with CF had inferior survival and longer ICU LOS when receiving organs from donors ≥55 years. 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 Dept. of Cardiothoracic Surgery, Oslo University Hospital Rikshospitalet, Norway

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

Authorship information

Author-Areas of participation

Auråen H-Research design, writing, performance of research, data analysis

Durheim MT-Research design, writing, performance of research, data analysis

Dellgren G-Writing, performance of research

Hämmäinen P-Writing, performance of research

Larsson H-Writing, performance of research

Geiran O-Writing, performance of research

Lawaetz Schultz HH-Writing, performance of research

Leuckfeld I-Writing, performance of research

Iversen M-Writing, performance of research

Fiane AE-Writing, performance of research

Holm AM-Research design, writing, performance of research, data analysis

Conflict of interest statement:

The authors declare no conflicts of interest.

Funding:

First author Auråen H received funding from The Norwegian Respiratory Society to conduct this research.

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