Clinical implications of donor age: A single-institution analysis spanning 3 decades

Christopher T. Holley, Rosemary F Kelly, Sara J Shumway, Roland Z. Brown, Marshall I Hertz, Kyle Rudser, Coco W. Quinlan, Irena Cich, Gabriel Loor

Research output: Contribution to journalArticle

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)2126-2133.e2
JournalJournal of Thoracic and Cardiovascular Surgery
Volume154
Issue number6
DOIs
StatePublished - Dec 2017

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Tissue Donors
Bronchiolitis Obliterans
Primary Graft Dysfunction
Lung
Survival
Transplants
Mortality
Proportional Hazards Models
Comorbidity
Age Groups
Logistic Models
Morbidity

Keywords

  • donor age
  • lung transplant
  • lung transplant mortality
  • lung transplant survival

Cite this

Clinical implications of donor age : A single-institution analysis spanning 3 decades. / Holley, Christopher T.; Kelly, Rosemary F; Shumway, Sara J; Brown, Roland Z.; Hertz, Marshall I; Rudser, Kyle; Quinlan, Coco W.; Cich, Irena; Loor, Gabriel.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 154, No. 6, 12.2017, p. 2126-2133.e2.

Research output: Contribution to journalArticle

Holley, Christopher T. ; Kelly, Rosemary F ; Shumway, Sara J ; Brown, Roland Z. ; Hertz, Marshall I ; Rudser, Kyle ; Quinlan, Coco W. ; Cich, Irena ; Loor, Gabriel. / Clinical implications of donor age : A single-institution analysis spanning 3 decades. In: Journal of Thoracic and Cardiovascular Surgery. 2017 ; Vol. 154, No. 6. pp. 2126-2133.e2.
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abstract = "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.",
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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.

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