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Published on: August 15, 2022
Differential Impact of Extended-Criteria Donor Use According to Recipient Status in Lung Transplantation: A
Hye Ju Yeo1,2, Jin Ho Jang1,2, Eunjeong Choi1,2
1Transplant Research Center, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.
Background:
The use of extended-criteria donors (ECDs) in lung transplantation remains high in Korea; however, their impact on survival outcomes is not fully understood.
Methods:
We retrospectively analyzed 1,251 adult lung transplant recipients registered with the Korea Network for Organ Sharing (2010-2023). ECDs were defined as donors aged ≥ 55 years with a smoking history ≥ 20 pack-years or a PaO₂/FiO₂ ratio ≤ 300. Survival outcomes were assessed using Kaplan-Meier analysis and multivariable Cox regression, with subgroup comparisons by urgency (status 0 vs. status 1-4) and age (< 65 vs. ≥ 65 years).
Results:
Of the 1,251 recipients, 33.7% received ECD lungs. In the multivariable analysis, recipient age, urgency status 0, and ECD use were independently associated with increased one-year mortality. In subgroup analyses, ECD use was consistently associated with higher mortality in status 1-4 recipients (P < 0.001), whereas in status 0 recipients it showed only a trend toward decreased survival (P = 0.056). Among elderly recipients, ECD use significantly increased mortality in status 1-4 but showed only a trend toward decreased survival in status 0 (P = 0.071). In contrast, among younger recipients, ECD use increased mortality in status 1-4 but had no significant effect in status 0.
Conclusion:
ECD use was consistently associated with higher one-year mortality in recipients with urgency status 1-4, irrespective of age. In contrast, among status 0 recipients, the effect differed by age. These findings highlight the importance of incorporating both recipient urgency and age into donor lung selection.
