Marcia Frellick

May 02, 2016

WASHINGTON, DC — For people who undergo lung transplantation, mortality risk is only slightly higher when donors are 55 to 64 years of age than when they are younger than 55 years, the current age recommendation, according to an analysis of the world's largest lung transplant registry.

However, when the donors were older than 64 years, there were significant reductions in long-term survival.

"In light of these data, it should be investigated whether and how the acceptable donor age can be safely increased to 64 years, which would have the potential to significantly expand the pool of donor lungs," lead researcher Alexander Bernhardt, MD, from the Department of Cardiovascular Surgery at the University Heart Center in Hamburg, Germany, and colleagues write.

But for now, Dr Bernhardt advised prudence when considering an across-the-board increase in the recommended age for donors.

"For certain patients, for certain diagnoses, and with regard to urgency in some patients, it's good to accept older donor lungs, but with a lot of caution. It's not the way to go for every patient," he said here at the International Society for Heart and Lung Transplantation (ISHLT) 2016 Scientific Sessions.

For their study, Dr Bernhardt and his colleagues analyzed the 43,155 primary lung transplantations performed from 1988 to 2012 in the ISHLT database.

The mortality rate for recipients of lungs from donors 55 to 64 years of age was only slightly higher than that for donors younger than 55 years (mortality hazard ratio, 1.15; 95% confidence interval, 1.08 - 1.21; P < .001).

Recipient survival was similar for donors of all age groups at 1 year. But recipient survival at 5 years was worse for donors 65 years and older than for younger donors.

Table. Recipient Survival Rates by Donor Age

Donor Age n 1-Year Survival, % 5-Year Survival, %
<55 years 37,887 80.3 53.8
55 to 64 4499 78.2 52.9
≥65 years 769 73.7 45.4


Subgroup analysis revealed no significant differences in survival among the three age groups for patients with pulmonary hypertension, cystic fibrosis, or alpha1-antitrypsin deficiency than for patients with other diagnoses. These findings were similar after adjustment for recipient characteristics, Dr Bernhardt reported.

Rates of severe renal dysfunction, drug-treated hypertension, hyperlipidemia, and malignancy were also similar among the three donor age groups.

The large numbers in this study add weight to the results and make a case for further monitoring, said Arne Neyrinck, MD, PhD, from the Department of Anesthesiology at University Hospitals in Leuven, Belgium.

However, he also urged caution when interpreting the results or changing practice. The role of recipient factors in outcomes was not accounted for in the study, he told Medscape Medical News, and "the risk of dying on the waiting list if you did not use these old organs is also not taken into account."

The role of recipient factors is currently being analyzed, said Dr Bernhardt, and he is working on a multivariate analysis to highlight risks and benefits.

A previous review of data from the United Network for Organ Sharing database also showed little additional short-term mortality risk when donor age was pushed to 64 years (J Heart Lung Transplant. 2013;32:760-768).

In that study, compared with donor age from 18 to 34 years, donor age from 55 to 64 years was not a risk factor for mortality at 1 year (odds ratio [OR], 1.1; P = .304) or 3 years (OR, 0.923; P = .571). However, donor age older than 65 was linked to increased mortality at 1 year (OR, 2.8; P < .02) and at 3 years (OR, 2.4; P < .02).

Dr Bernhardt, the study authors, and Dr Neyrinck have disclosed no relevant financial relationships.

International Society for Heart and Lung Transplantation (ISHLT) 2016 Scientific Sessions: Abstract 0253. Presented April 29, 2016.


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