Lung Transplant Outcome From Selected Older Donors (≥70 Years) Equals Younger Donors (< /70 Years) A Propensity-matched Analysis

Vanluyten, Cedric; Vandervelde, Christelle M; Vos, Robin; Van Slambrouck, Jan; Fieuws, Steffen; De Leyn, Paul; Nafteux, Philippe; Decaluwe, Herbert; Van Veer, Hans; Depypere, Lieven; Jansen, Yanina; Provoost, An-Lies; Neyrinck, Arne P; Ingels, Catherine; Vanaudenaerde, Bart M; Godinas, Laurent; Dupont, Lieven J; Verleden, Geert M; Van Raemdonck, Dirk; Ceulemans, Laurens J

doi:10.1097/SLA.0000000000005813

Lung Transplant Outcome From Selected Older Donors (≥70 Years) Equals Younger Donors (< /70 Years) A Propensity-matched Analysis

Author:

Vanluyten, Cedric

Vandervelde, Christelle M ; Vos, Robin ; Van Slambrouck, Jan ; Fieuws, Steffen ; De Leyn, Paul ; Nafteux, Philippe ; Decaluwe, Herbert ; Van Veer, Hans ; Depypere, Lieven ; Jansen, Yanina ; Provoost, An-Lies ; Neyrinck, Arne P ; Ingels, Catherine ; Vanaudenaerde, Bart M ; Godinas, Laurent ; Dupont, Lieven J ; Verleden, Geert M ; Van Raemdonck, Dirk ; Ceulemans, Laurens J

Keywords:

Science & Technology, Life Sciences & Biomedicine, Surgery, extended-criteria donor, lung transplantation, old donor, propensity score matching, INTERNATIONAL SOCIETY, CRITERIA, HEART, AGE, DEFINITION, RECIPIENTS, SURVIVAL, REGISTRY, GRAFTS, Humans, Aged, Aged, 80 and over, Retrospective Studies, Primary Graft Dysfunction, Treatment Outcome, Tissue Donors, Lung Transplantation, Oxygen, 1803521N#56522477, 11 Medical and Health Sciences, 3202 Clinical sciences

Abstract:

OBJECTIVE: To describe our experience with lung transplantation (LTx) from donors ≥70 years and compare short and long-term outcomes to a propensity-matched cohort of donors <70 years. BACKGROUND: Although extended-criteria donors have been widely used to enlarge the donor pool, the experience with LTx from older donors (≥70 years) remains limited. METHODS: All single-center bilateral LTx between 2010 and 2020 were retrospectively analyzed. Matching (1:1) was performed for the donor (type, sex, smoking history, x-ray abnormalities, partial pressure of oxygen/fraction of inspired oxygen ratio, and time on ventilator) and recipient characteristics (age, sex, LTx indication, perioperative extracorporeal life support, and cytomegalovirus mismatch). Primary graft dysfunction grade-3, 5-year patient, and chronic lung allograft dysfunction-free survival were analyzed. RESULTS: Out of 647 bilateral LTx, 69 were performed from donors ≥70 years. The mean age in the older donor cohort was 74 years (range: 70-84 years) versus 49 years (range: 12-69 years) in the matched younger group. No significant differences were observed in the length of ventilatory support, intensive care unit, or hospital stay. Primary graft dysfunction-3 was 26% in the older group versus 29% in younger donor recipients ( P = 0.85). Reintervention rate was comparable (29% vs 16%; P = 0.10). Follow-up bronchoscopy revealed no difference in bronchial anastomotic complications ( P = 1.00). Five-year patient and chronic lung allograft dysfunction-free survivals were 73.6% versus 73.1% ( P = 0.72) and 51.5% versus 59.2% ( P = 0.41), respectively. CONCLUSIONS: LTx from selected donors ≥70 years is feasible and safe, yielding comparable short and long-term outcomes in a propensity-matched analysis with younger donors (<70 years).