Effect of Donor Age on Survival in Lung Transplantation: A Multicentric Retrospective Study

OBJECTIVES: Shortage of organ requires to consider older donors of lung transplants, but the consequence of donor age on the outcomes of lung transplant recipients (LTRs) is not clearly established. Our objective was to determine the impact of donor age on LTR survival. METHODS: We analysed data from a multicentre cohort of 1191 LTR. The main outcome was the time from transplantation to death. Multivariate Cox regression associated with G-computation were used to obtain confounder-adjusted results. RESULTS: Lung graft from donor over 60 years of age are more frequently allocated to older recipients, female recipients, and candidates with chronic obstructive pulmonary disease and cardiovascular comorbidities. The 5-year confounder-adjusted survival of recipients with lung from donor over 60 was lower than that of recipients of transplants from younger donors (62.1% vs 69.3%, respectively, P < .001). The corresponding HR was 1.28 (95% CI, 1.01-1.63). For such a follow-up at 5 years, the mean life expectancy was 46.4 months (95% CI, 44.4-48.3) in the group receiving a younger graft versus 42.6 months (95% CI, 39.6-45.6) in the older group. It corresponded to significant difference of 3.8 months gain in the 5-year life expectancy (P = .028). CONCLUSIONS: Donor age over 60 is an independent risk factor for reduced post-transplant survival. The age criterion must be taken into account when accepting a lung graft as a potential impact to the recipient's survival. CLINICAL TRIAL NOTATION: NCT00980967.