Does donor age older or younger than 70 years influence lung transplantation outcomes?

For lung transplantation (LTx) we are lacking long-term outcomes using older donors. The aim of our study was to evaluate our cohort regarding the use of donors aged 70 years and older compared with those younger than age 70 years after LTx.

In a retrospective single-center study including all LTx procedures performed between 2006 and 2024 (n = 689) we compared short- and long-term mortality and retransplantation between groups based on donor age older or younger than 70 years.

Recipients with older donors (n = 75 [10.9%]) were older (60.4 ± 9.5 years vs 52.7 ± 14.1 years; P < .0001), shorter (P = .024), had a larger proportion with a history of smoking (P = .014), and a lower preoperative forced expiratory volume in 1 second (P = .011). Older donors were more often women (P = .0027), had a shorter donor height (P < .0001), and the cause of death was more frequently intracranial hemorrhage (P < .0001). One-year mortality was comparable (donors younger than age 70 years: 12.5%, donors aged 70 years and older: 10.7%; P = .64). Forced expiratory volume in 1 second at 1 year was higher in recipients with younger donors (P = .0052). In a Cox regression analysis recipient age (P < .0001), body mass index (P = 0.039), donor age per 10 years increase (P = .03), and donor age 70 years and older (P = .026) were significantly associated with long-term mortality. Overall survival was lower for recipients with older donors (adjusted hazard ratio, 1.44; 95% CI, 1.04-1.97; P = .026). After propensity score matching, differences remained with poorer survival in recipients with older donors (hazard ratio, 1.62; 95% CI, 1.02-2.6; P = .043).

This study shows that 1-year survival using grafts from donors older than age 70 years is comparable to those of younger donors, but long-term survival is inferior, which indicates that grafts from older donors should be used in selected patients undergoing LTx.