Survival and spirometry outcomes after lung transplantation from donors aged 70 years and older

BACKGROUND: Mediocre donation rates and increasing demand for lung transplantation leads transplant centers to consider extended-criteria donor lungs. Arguably, the largest remaining nonutilized lung donor segment is the elderly individual, already considered for visceral organ donation but not thoracic. So far, transplantation of donor lungs aged >= 70 years is rarely reported, and recipient outcomes are unknown. Accordingly, we report a single-center series of lung transplantations from donors aged 70 years and compare outcomes with contemporary lung transplantations from younger donors. METHODS: All bilateral lung transplantations performed at our center between March 2011 and July 2014 were analyzed, and 2 cohorts were built according to lung donor age. RESULTS: A total of 440 bilateral lung transplantations were performed from 413 donors aged <70 years, and 27 donors aged >= 70 years. Donor characteristics did not differ in sex, donor time on mechanical ventilation before retrieval, or donor partial pressure of arterial oxygen/fraction of inspired oxygen ratio. Older donors were significantly less often positive for smoking history (43.7% vs 14.8%, p = 0.003) or for abnormal bronchoscopy results (52.9% vs 15.8%, p = 0.002). Recipients receiving donor lungs aged <70 years were younger than those receiving older donor lungs >= 70 (49.8 [range, 35-58] vs 58 [range, 53-62] years, p < 0.0001). Underlying diagnoses did not differ significantly between the groups. Post-operative mechanical ventilation times (15 [range, 10-59] vs 27.5 [range, 10-75.8] hours), intensive care unit stays (3 [range, 1-5] vs 3 [range, 1-8] days), and total hospital lengths of stay (24 [range, 22-40.5] vs 24 [range, 22-40] days) of the recipients did not differ significantly between the two groups. The percentage predicted forced expiratory volume in 1 second was 86.5% +/- 26.2% 12 months after transplantation of younger lungs vs 72.2% +/- 23.8% (p = 0.01) after transplantation of older lungs. Differentiating the spirometry findings according to underlying diseases showed significantly lower forced expiratory volume in 1 second values after transplantation of donor lungs aged >= 70 only in idiopathic pulmonary fibrosis recipients but not in emphysema patients. Patient survival up to 36 months was not significantly different, with 1-year survival being 92.9% for younger vs 95.5% for older donor lungs. CONCLUSION: Use of donor lungs aged >= 70 years for transplantation is safe, without compromising survival. However, spirometry findings after transplantation with donors >= 70 years indicate better functional outcomes in emphysema recipients than in idiopathic pulmonary fibrosis recipients. (C) 2015 International Society for Heart and Lung Transplantation. All rights reserved.