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 language | English (US) |
|---|---|
| Pages (from-to) | 2126-2133.e2 |
| Journal | Journal of Thoracic and Cardiovascular Surgery |
| Volume | 154 |
| Issue number | 6 |
| DOIs | |
| State | Published - Dec 2017 |
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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 journal › Article
}
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
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
UR - http://www.scopus.com/inward/record.url?scp=85023609673&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85023609673&partnerID=8YFLogxK
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 -