Donor or recipient age are no barrier to lung transplantation - but beware co-morbidities!
Several recent studies, from both Europe and North America, including reviews of over 17,000 lung transplants on the UNOS data base, seem to confirm that age in itself (up to 70 years for donors and up to 80 for recipients) is not associated with worse outcomes compared with those under 50.
UNOS database
In one study, (Whited et al, 2017), UNOS data analysis of 14,222 lung transplants revealed that lungs from donors aged 60 years or more were associated with slightly worse 5-year survival rates (44% versus 52%). Among recipients aged more than 50 years, however, this trend was not evident in the multivariate model.
Among recipients aged 50 years or more, receiving older donor lungs showed worse survival rates with the use of single lung transplant (5-year survival 15% versus 50%, p = 0.01). In contrast, no significant difference in survival between young and old donors was seen when double lung transplant was performed (p = 0.491).
The authors conclude that “Reasonable post-transplant outcomes can be achieved with use of advanced age donors in all recipient groups. Double lung transplantation should be performed when older donors (> 60) are used in young recipients (age 50 or less).”
Donor / Recipient age mismatch…
In another recent UNOS data-mining exercise, Katsnelson et al examined the effect of a >10-year donor-recipient age difference among 3,227 elderly lung transplant recipients aged 65-80 at transplantation. Univariate analysis found no differences in lung transplant outcome involving donors at least 10 years younger than the recipient with respect to overall survival; (p = 0.831) or conditional survival past 1 y; (p = 0.629) compared with transplants where the donor / recipient age difference was less than 10 years.
Other smaller single center studies indicate similar conclusions. Hecker et al, for example, showed that lung transplantation from donors aged ≥70 years was not associated with worse outcomes compared with the younger donors.
Controlling for co-morbidities
Ehrsam et al report that although their recipients older than 60 years did have a lower median survival, the mortality difference was no longer statistically significant once they controlled for comorbid variables; – unsurprisingly, patients in the elderly population were more likely to have several of these comorbid conditions.
The authors conclude “The comorbidity profile, underlying disease, and donor lung quality appear to be more important than age in reducing long-term survival.”
References:
1. Whited et al, Does Donor Age and Double Versus Single Lung Transplant Affect Survival of Young Recipients? Ann. Thorac. Surg, on-line Nov 9 2017. (Link to abstract)
2. Katsnelson et al, Lung transplantation with lungs from older donors: an analysis of survival in elderly recipients. J Surg Res. 214: 109-116, 2017 (link to abstract)
3. Hecker et al , Use of very old donors for lung transplantation: a dual-centre retrospective analysis., Eur J Cardiothorac Surg. 2017 Jul 17. doi: 10.1093/ejcts/ezx202. [Epub ahead of print] (link to abstract)
4. Ehrsam J P et al, Lung transplantation in the elderly: Influence of age, comorbidities, underlying disease, and extended criteria donor lungs. J Thorac Cardiovasc Surg 154 (6), 2135-2141. 2017 Jul 29. (link to abstract)
Xvivo Insights PB-2017-11-28
