Influence of donor and recipient age in lung transplantation

Background No restrictions exist for allocating donor lungs according to age in the United States.

Methods A retrospective cohort study was performed of lung transplant recipients from 1987 to 2013 through a query of the United Network for Organ Sharing (UNOS) thoracic database. Age thresholds used were recipients (R) aged 60 years (R60 group) and 65 years (R65 group) and donors aged 50 years; each sub-group was analyzed, totaling 8 groups.

Results Of 23,905 lung transplants, 23,704 were used for Kaplan-Meier analysis, 8,851 for multivariate Cox, and 3,206 for the R60 group and 3,212 for the R65 group propensity score-matching analysis. Kaplan-Meier analysis with log-rank test statistic indicated significant differences across binary measure of donor age with a threshold of 60 years (log-rank test: chi-square₁ = 12.9558, p = 0.0003) and 65 years (log-rank test: chi-square₁ = 15.5053, p = 0.0001). Multivariate Cox models demonstrated that donors aged <50 years and ≥50 years significantly reduced the risk for death for the R60 group, whereas only donors aged <50 years decreased risk for death for the R65 group (hazard ratio [HR], 0.730; 95% confidence interval [CI], 0.623-0.856; p < 0.001) after lung transplant. Propensity score-matching analysis showed donors aged ≥50 years increased the risk for death of recipients aged <60 years (HR, 1.314; 95% CI, 1.065-1.621; p = 0.011) and <65 years (HR, 1.198; 95% CI, 1.089-1.319, p < 0.001), whereas donors aged ≥50 years did not increase the risk for death for recipients aged ≥60 years (HR, 1.056; 95% CI, 0.869-1.285; p = 0.583) and ≥65 years (HR, 0.938; 95% CI, 0.705, 1.249, p = 0.662).

Conclusions Older donor lungs did not negatively affect survival in older recipients but limited outcomes in younger recipients.