TY - JOUR
T1 - Clinical implications of donor age
T2 - A single-institution analysis spanning 3 decades
AU - Holley, Christopher T.
AU - Kelly, Rosemary F
AU - Shumway, Sara J
AU - Brown, Roland Z.
AU - Hertz, Marshall I
AU - Rudser, Kyle
AU - Quinlan, Coco W.
AU - Cich, Irena
AU - Loor, Gabriel
N1 - Publisher Copyright:
© 2017 The American Association for Thoracic Surgery
Copyright:
Copyright 2017 Elsevier B.V., All rights reserved.
PY - 2017/12
Y1 - 2017/12
N2 - Background We sought to clarify the effect of donor age as a continuous variable on morbidity and mortality in a single-institution experience. Methods From 1986 to 2016, 882 adult lung transplants were performed, including 396 in the lung allocation score era. Kaplan-Meier curves and Cox proportional hazards models were used to evaluate the association of donor age with overall survival and bronchiolitis obliterans syndrome (BOS) score ≥1-free survival. Logistic regression was used to evaluate the association with primary graft dysfunction grade 3. Natural cubic splines were used to explore donor age in a continuous fashion to allow for nonlinear relationships. Results In the lung allocation score era, unadjusted 5-year survival was not significantly different between 3 a priori–defined donor age groups: age <40, 40 to 54, and age ≥55 years (64%, 61%, and 69%, P =.8). Unadjusted 5-year freedom from BOS ≥1 was not significantly different (34%, 20%, and 33%, respectively, P =.1). After we adjusted for comorbidities, cubic spline analysis demonstrated no effect between donor age as a continuous variable and hazard for mortality at 5 years. Similarly, no interaction was seen between donor age and risk of BOS or primary graft dysfunction 3. Adjusted analysis of all 882 transplants pre- and postinception of the lung allocation score also showed no effect of age on 10-year survival. Conclusions Long-term survival of lung transplant recipients was not affected by the age of the donor. These findings support the notion that donor age could be relaxed.
AB - Background We sought to clarify the effect of donor age as a continuous variable on morbidity and mortality in a single-institution experience. Methods From 1986 to 2016, 882 adult lung transplants were performed, including 396 in the lung allocation score era. Kaplan-Meier curves and Cox proportional hazards models were used to evaluate the association of donor age with overall survival and bronchiolitis obliterans syndrome (BOS) score ≥1-free survival. Logistic regression was used to evaluate the association with primary graft dysfunction grade 3. Natural cubic splines were used to explore donor age in a continuous fashion to allow for nonlinear relationships. Results In the lung allocation score era, unadjusted 5-year survival was not significantly different between 3 a priori–defined donor age groups: age <40, 40 to 54, and age ≥55 years (64%, 61%, and 69%, P =.8). Unadjusted 5-year freedom from BOS ≥1 was not significantly different (34%, 20%, and 33%, respectively, P =.1). After we adjusted for comorbidities, cubic spline analysis demonstrated no effect between donor age as a continuous variable and hazard for mortality at 5 years. Similarly, no interaction was seen between donor age and risk of BOS or primary graft dysfunction 3. Adjusted analysis of all 882 transplants pre- and postinception of the lung allocation score also showed no effect of age on 10-year survival. Conclusions Long-term survival of lung transplant recipients was not affected by the age of the donor. These findings support the notion that donor age could be relaxed.
KW - donor age
KW - lung transplant
KW - lung transplant mortality
KW - lung transplant survival
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U2 - 10.1016/j.jtcvs.2017.06.029
DO - 10.1016/j.jtcvs.2017.06.029
M3 - Article
C2 - 28712587
AN - SCOPUS:85023609673
VL - 154
SP - 2126-2133.e2
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
SN - 0022-5223
IS - 6
ER -