Impact of Age Difference Between Donor and Recipient on Intermediate- and Long-Term Survival in Lung Transplant...

The impact of donor-recipient age difference on survival after lung transplantation (LTx) remains unclear. This study investigates effects in different recipient age groups to optimize donor-recipient matching.

Analysing United Network for Organ Sharing (UNOS) data (2005-2015), we stratified adult first-time LTx recipients into 3 age strata (18-40, 40-60, 60-80 years). Donor-recipient age difference (Δ = donor age-recipient age) was classified into Δ  <  0 and Δ ≥ 0 groups; the 60-80 stratum was further divided into Δ < -10 and Δ  <  0 to ≤ -10 groups. Outcomes included 5-year (primary) and 10-year patient and graft survival, with subgroup analyses by underlying pulmonary disease.

Δ  <  0 was associated with significantly better 5-year graft survival in the 18-40 and 40-60 strata (adjusted hazard ratio [HR]: 1.21 [1.02-1.44], P = .031 in 18-40; 1.19 [1.05-1.35], P = .006 in 40-60). Among recipients aged 60-80 (Δ < 0 only), Δ<-10 showed superior 5-year patient survival compared to Δ  <  0 to ≤ -10 (adjusted HR 1.23 [1.10-1.37], P < .001). Secondary analyses showed in 40-60, Δ < 0 had better 10-year patient survival (adjusted HR: 1.14 [1.02-1.27], P = .017); and in 60-80, Δ<-10 remained favourable (adjusted HR: 1.12 [1.02-1.23], P = .015). Subgroup analyses confirmed greater benefit younger donors in cystic fibrosis recipients aged 18-40 and 40-60, and idiopathic pulmonary fibrosis recipients aged 60-80.

Younger donors correlate with better intermediate- and long-term post-transplant survival, particularly for graft survival, supporting individualized preferential matching when clinically feasible.