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J Thorac Cardiovasc Surg 2005;129:919-925
© 2005 The American Association for Thoracic Surgery

Cardiothoracic Transplantation

Lung transplantation with lungs from donors fifty years of age and older

^a Hannover Thoracic Transplant Program, Division of Thoracic- and Cardiovascular Surgery, Hannover Medical School, Hannover, Germany
^b Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany

Presented at the Twenty-fourth Annual Meeting of the International Society for Heart and Lung Transplantation (ISHLT), 2004, San Francisco, Calif.

Received for publication April 14, 2004; revisions received July 26, 2004; accepted for publication July 28, 2004.

^_* Address for reprints: Martin Strüber, MD, Director, Hannover Thoracic Transplant Program, Division of Cardiothoracic and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Strasse 1, Hannover, 30625, Germany (E-mail: strueber{at}thg.mh-hannover.de).

BACKGROUND: A shortage of donors has led to the progressive expansion of criteria for donor selection in lung transplantation. The outcome of recipients of lungs from donors aged 50 years or older is analyzed systematically.

METHODS: From March 1998 to June 2003, 49 recipients received lungs from donors aged 50 years or older (range 50–64 years, mean 54 ± 3 years). This group of recipients was compared with 244 patients receiving lungs from donors aged less than 50 years (range 7–49 years, mean 32 ± 11 years). This study was undertaken on all 293 patients at our institution who received Perfadex-preserved lungs (Vitrolife, Göteborg, Sweden).

RESULTS: Recipient age, sex, and indications for transplant did not differ significantly between groups. Also, the percentage of the different types of transplants (bilateral or single lung transplantation) performed was equal in both cohorts. Donor Pao₂/Fio₂ ratios before lung retrieval (415 ± 91 vs 439 ± 113, respectively) and length of ischemic time (347 ± 67 minutes vs 351 ± 84 minutes, respectively) did not differ significantly between the older and younger donor groups. The following posttransplant parameters were also not statistically different: first Pao₂/Fio₂ at intensive care unit arrival (274 ± 125 in the older donor group vs 253 ± 119 in the younger donor group, respectively), mechanical ventilation time (328 ± 427 hours vs 269 ± 425 hours, respectively), and length of stay in the intensive care unit (16 ± 18 days vs 14 ± 18 days, respectively). Recipient survival in the older and younger donor groups at 30 days, 3, 6, 12, 24, and 60 months was 77% ± 6%, 75% ± 6%, 73% ± 7%, 73% ± 7%, 68% ± 5%, and 68% ± 4% versus 86% ± 2%, 83% ± 3%, 80% ± 3%, 78% ± 3%, 71% ± 4%, and 66% ± 4%, respectively.

CONCLUSIONS: Lung grafts from elderly donors have been considered as marginal organs for transplantation. However, this study indicates that transplantation of lungs from carefully selected donors aged 50 years or more may lead to similar short- and long-term outcomes compared with lungs from younger donors. The use of lungs from elderly donors may help to increase the number of donor organs in lung transplantation.

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