Donors in lung transplantation: does age matter?

Area of Science:

• Transplantation immunology
• Thoracic surgery
• Donor organ utilization

Background:

• Lung transplantation is a life-saving procedure for end-stage respiratory diseases.
• Optimizing donor organ utilization is crucial given organ shortages.
• The impact of donor age on lung transplant outcomes requires careful evaluation.

Purpose of the Study:

• To determine if lung grafts from donors over 60 years old are associated with equivalent outcomes compared to grafts from donors 60 years or younger.
• To analyze outcomes including primary graft dysfunction, respiratory function, and survival in lung transplant recipients.

Main Methods:

• A best-evidence systematic review was conducted.
• A comprehensive literature search identified over 200 relevant papers.
• Twelve high-quality papers formed the basis for answering the clinical question.

Main Results:

• Survival outcomes varied based on whether donor age was analyzed raw or adjusted for recipient factors.
• Recipients with interstitial lung disease (ILD), pulmonary hypertension, or cystic fibrosis (CF) showed inferior survival with older donor lungs.
• While some studies indicated worse forced expiratory volume in 1-second (FEV1), primary graft dysfunction rates were comparable in some cases.

Conclusions:

• Lung grafts from donors over 60 years old can offer comparable results to younger donor lungs when carefully assessed and allocated.
• Specific recipient populations, such as those with chronic obstructive pulmonary disease (COPD), may benefit most from older donor lungs, especially if prolonged cardiopulmonary bypass (CPB) is not required.