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| Impact Of Donors Aged 60 Years And Older On Outcome After Lung Transplantation: Results Of An 11-year Single Center Experience |
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Back to 86th Annual Meeting Back to Program Outline Objectives: To examine the outcome of lung transplantation with utilization of donors aged 60 and older. Methods: From 05/1994 to 05/2005, 467 lung transplants were performed in our institution. A total of 60 recipients received lungs from donors ≥60 years old (range 60-77, median 65 years), whereas 407 received lungs from younger donors (range 9-59, median 39 years). The short and long-term survival of these two groups was compared. Results: Recipient gender, indication for transplant, and type of transplant were not significantly different between the two groups. Bilateral lung transplants was performed in 404 patients (55 in the older donor group), single lung transplant in 50 (5 in the older donor group), and heart-lung transplant in 13 (0 in the older donor group). The mean recipient age tended to be older in the older donor group (49±15 years vs 45±15 years in the younger donor group, p=0.05). A total of 48 patients (10%) died within 30 days of surgery; 10 (17%) in the older donor group vs 38 (9%) in the younger donor group (p=0.07). Primary graft dysfunction was the cause of death in 13 patients (3 in the older donor group vs 10 in the younger donor group, p=0.8). The 90-day mortality was greater in the older donor group (n=13, 22% vs n=48, 12% in the younger donor group, p=0.03). However, the 90-day mortality varied with the underlying recipient lung disease and was greater in patients with pulmonary hypertension (12/46, 26%) and pulmonary fibrosis (21/111, 19%) than with emphysema (12/129, 12%) and cystic fibrosis (11/110, 10%) (p=0.009). A total of 210 patients died after a median follow-up of 25 months (range 0-136 months). The overall 5- and 10-year cumulative survival was 57% and 36%, respectively. However, the survival tended to be worse in the older donor group (48% and 15% at 5 and 10 years vs 58% and 38% respectively in the younger donor group, p=0.07 by log-rank test). A total of 56 patients died from bronchiolitis obliterans syndrome (BOS). BOS was the predominant cause of death in recipients from older donors who survived for longer than 90 days (11/17, 65% vs 45/132, 34% in recipients from younger donors surviving for longer than 90 days, p=0.01). The long-term survival was not influenced by recipient gender, age, underlying lung disease, or type of transplant. Conclusions: Given the lack of organ donors, lungs transplanted from donors ≥60 years old can save the lives of many patients dying of end-stage lung disease while on the waiting list, and the use of extended lung donors has in balance allowed more lives to be saved overall. However, considering the total burden of injury the transplanted lung is enduring, not unexpectedly, the use of donors ≥60yr is associated with a lower survival rate and BOS plays a significantly greater role as the cause of late death in recipients from older donors. Back to 86th Annual Meeting Back to Program Outline |
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