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J Thorac Cardiovasc Surg 2007;133:525-531
© 2007 The American Association for Thoracic Surgery

Cardiothoracic Transplantation

Impact of donors aged 60 years or more on outcome after lung transplantation: Results of an 11-year single-center experience

Marc De Perrot, MD, MSc*, Thomas K. Waddell, MD, PhD, Yaron Shargall, MD, Andrew F. Pierre, MD, MSc, Elie Fadel, MD, Karl Uy, MD, Cecilia Chaparro, MD, Michael Hutcheon, MD, Lianne G. Singer, MD, Shaf Keshavjee, MD, MSc

Toronto Lung Transplant Program, Toronto General Hospital, University of Toronto, Toronto, Canada.

Read at the Eighty-sixth Annual Meeting of The American Association for Thoracic Surgery, Philadelphia, Pa, April 29-May 3, 2006.

Received for publication April 29, 2006; revisions received August 16, 2006; accepted for publication September 5, 2006.

* Reprint requests: Marc de Perrot, MD, MSc, Toronto General Hospital, 9N-961, 200 Elizabeth St, Toronto, Ontario, Canada M5G 2C4. (Email: marc.deperrot{at}uhn.on.ca).


   Abstract
Top
 Abstract
Introduction
 Materials and Methods
 Results
 Discussion
 Conclusions
 References
 
OBJECTIVE: We examined the outcome of lung transplantation with the use of donors aged 60 years or more.

METHODS: From May 1994 to May 2005, 467 lung transplants were performed at our institution. A total of 60 recipients received lungs from donors aged 60 years or more (range 60–77 years, median 65 years), whereas 407 recipients received lungs from younger donors (range 9–59, median 39 years).

RESULTS: A total of 48 patients (10%) died within 30 days of surgery: 10 (17%) in the older donor group versus 38 (9%) in the younger donor group (P = .08). The operative mortality varied with the underlying lung disease and was higher in recipients presenting with pulmonary hypertension and pulmonary fibrosis than with emphysema or cystic fibrosis. A total of 210 patients died after a median follow-up of 25 months (range 0–136 months). The overall 5- and 10-year survivals were 57% and 38%, respectively. However, the 10-year survival tended to be worse in the older donor group (16% vs 39% in the younger donor group, P = .07). Bronchiolitis obliterans syndrome was the predominant cause of death in recipients of older donors who survived for more than 90 days after surgery (11/17, 65% vs 45/132, 34% in recipients of younger donors surviving for >90 days after surgery, P = .01).

CONCLUSIONS: Given the lack of organ donors, lungs from donors aged 60 years or more should be considered for transplantation. However, the use of donors aged 60 years or more is associated with a lower 10-year survival, and bronchiolitis obliterans syndrome plays a significant role as the cause of late death.

Abbreviation and Acronym BOS = bronchiolitis obliterans syndrome


   Introduction
Top
 Abstract
 Introduction
Materials and Methods
 Results
 Discussion
 Conclusions
 References
 
Lung transplantation has had increasing success and has become the mainstay of therapy for most end-stage lung diseases. The Registry of the International Society for Heart and Lung Transplantation reported in 2005 that more than 15,000 lung transplants have been performed worldwide, and approximately 1500 lung transplants are performed annually.1Go During the past 15 years, the number of recipients on the waiting list has been progressively increasing and now far exceeds the number of organs available. Consequently, the median waiting time for lung transplantation has nearly doubled in North America and Europe, and 20% to 30% of the patients awaiting lung transplantation are currently dying.2Go

A number of strategies have been advocated to increase the number of donors. Some centers have developed a living-related lung donor program, whereas others have focused on non–heart beating donors to ultimately palliate the lack of donors. Although living-related donors have been used successfully3Go and non–heart beating donors have been shown to be feasible in humans,4Go these strategies have remained limited to a small number of patients because of technical, medical, and ethical considerations.

The persistent shortage of lung donors has led to increasing interest in reevaluating the existing lung donor pool. Over the years, improvement in donor management and refinement in techniques of lung preservation have allowed expansion of some of the donor selection criteria without significant impact on the early morbidity and mortality after lung transplantation.5-8Go However, despite the increasing use of marginal or extended donor lungs, extension of the selection criteria to donors aged 60 years or more is still considered as a contraindication for lung transplantation by the large majority of centers, and many lung donors are currently refused on the basis of age only. During the last several years, we have adopted a policy to not disqualify donors solely on the basis of age but to consider the lungs for transplantation if they fulfill other selection criteria. In this report, we analyzed the results from a series of 60 consecutive donors aged 60 years or more who were used for lung transplantation at our institution. The early and late outcomes were then compared with the group of recipients with transplants from donors aged less than 60 years at our institution during the same period.


   Materials and Methods
Top
 Abstract
 Introduction
 Materials and Methods
Results
 Discussion
 Conclusions
 References
 
Between May 1994 and May 2005, 467 patients underwent lung transplantation at our institution. A total of 60 patients (12.8%) received lungs from donors aged 60 years or more during this time period. Data for these 60 patients were retrospectively collected after the study was approved by our institutional review board. Donor information included gender, smoking history, oxygenation on 100% inspired fraction of oxygen, duration of intubation, cause of death, bronchoscopy findings, chest radiography abnormality, type of lung preservation, and ischemic time. The early and long-term outcomes for this group of patients (older donor group) were then compared with the group of 407 recipients who underwent transplantation at our institution during the same period but received lungs from donors aged less than 60 years (younger donor group). Recipient information included age, gender, diagnosis, type of lung transplant, and cause of death. Cause of death was assigned independently at our mortality review and prospectively collected in the database. Follow-up was complete for all patients until May 2005.

Donor management has been reviewed in detail elsewhere.9Go Briefly, all donors received intravenous methylprednisolone (15 mg/kg; Solu-Medrol, Upjohn, Don Mills, Ontario, Canada) after brain death declaration. Donors were maintained euvolemic to avoid excess fluid administration, and vasopressin was often used to maintain adequate blood pressure. The use of Euro-Collins (Fresenius, Lexington, Mass) was switched to low-potassium dextran solution (Perfadex; Vitrolife, Goteborg, Sweden) for lung preservation in April 1998. Only truly purulent secretions in distal airways were considered as abnormal on bronchoscopy. Chest radiography was considered abnormal in the presence of pulmonary contusion or infiltrates. The last PAO 2 was measured in the operating room after donor resuscitation and management by the retrieval team.

Surgical procedure, immunosuppression, and antibiotic prophylaxis have also been reviewed in detail elsewhere.10Go Recipients were chosen by the transplant surgeon, on the basis of blood type, size match, recipient status, time on the waiting list, and recipient age. Single lung transplant was usually performed through a posterolateral thoracotomy. Bilateral lung transplant and heart–lung transplant were performed through a clamshell incision.

Data are expressed as means ± standard deviation or as median and range. The Student t test was used to test differences between continuous variables, and the chi-square test was used for categoric variables. Multivariate analysis was performed by logistic regression analysis. Survival was calculated with the Kaplan–Meier method, and survival curves were compared using the log–rank test. Statview V (Abacus Concept, Berkeley, Calif) was used for all analyses.


   Results
Top
 Abstract
 Introduction
 Materials and Methods
 Results
Discussion
 Conclusions
 References
 
The number of donors aged 60 years or more, according to the number of lung transplantations performed every year at our institution, is shown in Figure 1. The number of older donors progressively increased over time, and currently approximate 15% to 20% of the lung transplants that are performed yearly at our institution.


Figure 1
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  		Figure 1. Proportion of transplants performed with donors aged 60 years or more at our institution between 1994 and 2004. Tx, Transplant.

 
The majority of older donors presented with no smoking history, no purulent secretions in distal airways, a short intubation time, and normal chest radiography (Table 1). The cause of death was mainly intracranial bleeding and was rarely secondary to trauma. A total of 24 donors had a smoking history. The smoking history was 20 pack-years or less in 10 donors and ranged between 30 and 75 pack-years in 14 donors. Nine donors presented with a PAO 2 of less than 300 mm Hg during the initial management, but only 2 donors had a PAO 2 that remained less than 300 mm Hg after aggressive donor resuscitation.


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  		Table 1. Characteristics of donors aged 60 years and older
 
Recipient and surgical characteristics were similar between those receiving lungs from donors aged 60 years or more and those receiving lungs from donors aged less than 60 years (Table 2). However, more women received lungs from older donors, and the mean recipient age tended to be older in the older donor group. Forty-four of the 46 recipients who underwent transplantation for pulmonary hypertension (idiopathic pulmonary arterial hypertension and Eisenmenger’s syndrome) received lungs from younger donors. The large majority of transplants were bilateral lung transplant in both older and younger donors. Older donors, however, were not used for heart–lung transplantation. The ischemic times were similar between the younger and older donor groups.


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  		Table 2. Recipient and surgical characteristics
 
A total of 48 patients (10%) died within 30 days from transplantation: 10 (17%) in the older donor group versus 38 (9%) in the younger donor group (P = .08). Causes of death were primary graft dysfunction in 13 patients (3 in the older donor group vs 10 in the younger donor group, P = .8), sepsis in 19 patients (5 in the older donor group vs 14 in the younger donor group, P = .6), and cardiac complications in 8 patients (2 in the older donor group vs 6 in the younger donor group, P = .8). An additional 8 patients died of other causes in the younger donor group.

The 30-day mortality varied with the underlying lung disease and was significantly higher in recipients presenting with pulmonary fibrosis and pulmonary hypertension than in recipients presenting with cystic fibrosis or emphysema (Table 3). In recipients presenting with cystic fibrosis, the death rate was 8% in the older and younger donor groups, and in recipients presenting with emphysema, the death rate was 0% in the older donor group and 7% in the younger donor group. In contrast, in the high-risk recipient group, the age of the donor seemed to be a significant risk factor. For pulmonary hypertension, both recipients of older donors died within 30 days of surgery, whereas in patients with pulmonary fibrosis, the 30-day mortality was 29% in the older donor group and 12% in the younger donor group.


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  		Table 3. Postoperative (30-day) mortality according to recipient’s diagnosis
 
Multivariate logistic regression analysis demonstrated that a diagnosis of pulmonary fibrosis or pulmonary hypertension and the use of cardiopulmonary bypass were associated with a significantly greater risk of death within 30 days after lung transplantation (Table 4). Although the risk of death within 30 days tended to be increased in recipients of donors aged 60 years and older, it did not reach statistical significance. Other factors, such as recipient age, type of transplant, and preservation solution, did not affect the 30-day mortality.


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  		Table 4. Risk factors for 30-day mortality
 
A total of 210 patients died after a median follow-up of 25 months (range 0-136 months). The overall 5- and 10-year cumulative survivals were 57% and 38%, respectively (Figure 2). However, the 10-year survival tended to be worse in the older donor group (16% vs 39% in the younger donor group, P = .07) (Figure 3). The long-term survival was not influenced by recipient gender (male vs female, P = .5), recipient age (<60 years vs ≥ 60 years, P = .3), or type of transplant (single vs bilateral, P = .7). The long-term survival was not significantly different between patients who underwent transplantation for emphysema (38% at 10 years), cystic fibrosis (34% at 10 years), pulmonary fibrosis (38% at 10 years), or pulmonary hypertension (55% at 10 years) (P = .4).


Figure 2
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  		Figure 2. Cumulative overall survival for all 467 recipients.

 

Figure 3
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  		Figure 3. Cumulative overall posttransplant survival of recipients who received lung transplants from donors aged more than and less than 60 years.

 
The causes of death were primarily bronchiolitis obliterans syndrome (BOS) and sepsis among recipients who survived for more than 90 days posttransplantation (Table 5). A total of 56 patients died of BOS, and 54 patients died of sepsis. BOS was the predominant cause of death in recipients of the older donor group who survived for more than 90 days after surgery, whereas sepsis was the predominant cause of death in recipients of the younger donor group who survived for more than 90 days after surgery. A total of 11 patients (65%) died of BOS in the older donor group, whereas 45 patients (34%) died of BOS in the younger donor group (P = .01). The other causes of death were not significantly different between the 2 groups.


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  		Table 5. Causes of death in recipients who died more than 90 days after their transplant
 
A total of 10 recipients received lungs from donors aged 70 years or more (median age 73 years, range 70-77 years). Recipient diagnoses were pulmonary fibrosis (n = 4), emphysema (n = 2), cystic fibrosis (n = 2), sarcoidosis (n = 1), and idiopathic pulmonary hemosiderosis (n = 1). All patients underwent bilateral lung transplantation. One patient died of primary graft dysfunction within 30 days of surgery, 1 patient died of sepsis 6 weeks after surgery, and 1 patient died of BOS 16 months after surgery. Seven patients are alive 6 to 82 months after transplantation with a cumulative 5-year survival of 60%.


   Discussion
Top
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
Conclusions
 References
 
The constantly increasing number of patients awaiting lung transplantation has led to a critical shortage of lung donors. Therefore, over the past few years, lung donor selection criteria have been progressively liberalized. Donors with prolonged intubation, significant smoking history, history of asthma, or abnormal chest radiography have been used for transplantation without significant impact on the early postoperative outcome.6,7Go Although donors aged more than 55 years represent a large group of potentially available donors, most programs have remained skeptical about using older donors for lung transplantation. Some reports mentioned the use of occasional donors aged more than 55 years, but the number has remained small and has generally been limited to donors aged less than 60 years.6-8Go

During the last few years, we have taken the policy to consider all donors for lung transplantation and to avoid disqualifying donors on the basis of age only. This study was performed to review our experience with the first 60 consecutive donors aged 60 years or more whom we have used for lung transplantation in our program. Most of the older donors were nonsmokers, were intubated for less than 2 days, and presented with normal bronchoscopy and normal chest radiography. However, with increasing experience, we have become less restrictive and occasionally accepted older donors with a history of smoking, abnormal chest radiography, or a PAO 2 less than 300 mm Hg.

To evaluate the impact of older donors on early and late outcome after lung transplantation, we have used for comparison the group of 407 consecutive recipients receiving lungs from donors aged less than 60 years during the same time period at our institution. When comparing the 2 groups, we observed that the 30-day postoperative mortality was increased when older donors were used in recipients who underwent transplantation for pulmonary fibrosis and pulmonary hypertension. In contrast, only 1 patient who underwent transplantation for cystic fibrosis and no patient who underwent transplantation for emphysema died within 30 days of transplant in the older donor group. Thus, these findings suggest that older donors can be safely used in low-risk recipients. In high-risk recipients (eg, those with pulmonary hypertension or pulmonary fibrosis), however, the use of older donors should be carefully evaluated.

Evaluation of the operative risk should be determined by the quality of the donor, length of ischemic time, and recipient risk factors.11-13Go An analysis from the United Network for Organ Sharing database showed that the interaction of older donor age and prolonged ischemic time was associated with increasing mortality at 1 month and at 1 year after lung transplantation.14Go Although this study had only 23 donors aged more than 55 years, it is interesting to see that the postoperative mortality rate exponentially increased in donors aged more than 55 years when the ischemic time was more than 7 to 8 hours. In our experience, the total ischemic time for the second lung was less than 8 hours in all but 4 recipients with donors aged 60 years or more. It must be noted, however, that lung preservation has improved over the years and that the ischemic time seems to have less importance because the use of Euro-Collins was switched to Perfadex.9Go

The long-term outcome after lung transplantation can be influenced by donor lung characteristics. Ciccone and colleagues15Go showed that recipients of donors with traumatic brain death experienced more severe rejection episodes during the first year posttransplantation and were predisposed to earlier development of BOS. In our experience, recipients of donors aged 60 years or more had lower 5- and 10-year survivals than recipients of younger donors. In addition, the cause of death was predominantly BOS in the older donor group, whereas it was predominantly sepsis in the younger donor group. Lower survival at 5 years after transplantation has also been observed in kidney and liver recipients who received their organs from donors aged more than 60 years.16,17Go Thus, considering the total burden of injury that the transplanted organ is expected to endure, not unexpectedly, the use of older donors is associated with lower long-term survival. However, given the current lack of organ donors, lungs transplanted from donors aged 60 years or more can save the lives of many patients who would otherwise be at risk of dying of end-stage lung disease while on the waiting list.

The proportion of cadaveric donors aged 60 years or more has been progressively increasing over the past decade and now exceeds 10% of all cadaveric donors available for transplantation.18,19Go In Canada, the rate of cadaveric donors aged 60 years or more has increased from 6% in 1992 to 15% or more in 1998 and thereafter.19Go Thus, liberalization of the age as criteria for lung donation could significantly expand the number of organs available. In our experience, the proportion of donors aged 60 years or more has varied between 15% and 20% of all lung transplantations performed since 2001 at our institution. These organs have been mainly allocated to older recipients and the most ill patients on the waiting list.


   Conclusions
Top
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
 Conclusions
References
 
This study demonstrates that lungs from older donors could be considered for transplantation if they fulfill all other lung donor selection criteria. An evaluation of the postoperative risk should, however, be performed on the basis of donor characteristics and recipient diagnosis. Recipients with pulmonary fibrosis or pulmonary hypertension certainly present higher-risk recipients in whom older donors should be used cautiously. Although donor age can affect long-term survival posttransplantation, given the current shortage of organs, older donors should be considered for lung transplantation and not be discarded on the basis of age only.


   References
Top
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
 Conclusions
 References
 

  1. Trulock EP, Edwards LB, Taylor DO, Boucek MM, Keck BM, Hertz MI. The registry of the International Society for Heart and Lung Transplantation: twenty-second official adult lung and heart-lung transplant report-2005. J Heart Lung Transplant 2005;24:956-967.[Medline]
  2. Fisher AJ, Dark JH, Corris PA. Improving donor lung evaluation: a new approach to increase organ supply for lung transplantation. Thorax 1998;53:818-820.[Free Full Text]
  3. Cohen RG, Starnes VA. Living donor lung transplantation. World J Surg 2001;25:244-250.[Medline]
  4. Steen S, Sjoberg T, Pierre L, Liao Q, Eriksson L, Algotsson L. Transplantation of lungs from a non-heart-beating donor. Lancet 2001;357:825-829.[Medline]
  5. Kron IL, Tribble CG, Kern JA, Daniel TM, Rose CE, Truwit JD, et al. Successful transplantation of marginally acceptable thoracic organs. Ann Surg 1993;217:518-522.[Medline]
  6. Sundaresan S, Semenkovich J, Ochoa L, Richardson G, Trulock EP, Cooper JD, et al. Successful outcome of lung transplantation is not compromised by the use of marginal donor lungs. J Thorac Cardiovasc Surg 1995;109:1075-1079.[Abstract/Free Full Text]
  7. Bhorade SM, Vigneswaran W, McCabe MA, Garrity ER. Liberalization of donor criteria may expand the donor pool without adverse consequence in lung transplantation. J Heart Lung Transplant 2000;19:1199-1204.[Medline]
  8. Gabbay E, Williams TJ, Griffiths AP, Macfarlane LM, Kotsimbos TC, Esmore DS, et al. Maximizing the utilization of donor organs offered for lung transplantation. Am J Respir Crit Care Med 1999;160:265-271.[Abstract/Free Full Text]
  9. de Perrot M, Liu M, Waddell TK, Keshavjee S. Ischemia-reperfusion-induced lung injury. Am J Respir Crit Care Med 2003;167:490-511.[Abstract/Free Full Text]
  10. de Perrot M, Chaparro C, McRae K, Waddell TK, Hadjiliadis D, Singer LG, et al. Twenty-year experience of lung transplantation at a single center: influence of recipient diagnosis on long-term survival. J Thorac Cardiovasc Surg 2004;127:1493-1501.[Abstract/Free Full Text]
  11. Pierre AF, Sekine Y, Hutcheon MA, Waddell TK, Keshavjee SH. Marginal donor lungs: a reassessment. J Thorac Cardiovasc Surg 2002;123:421-428.[Abstract/Free Full Text]
  12. Sekine Y, Waddell TK, Matte-Martyn A, Pierre AF, de Perrot M, Fischer S, et al. Risk quantification of early outcome after lung transplantation: donor, recipient, operative, and post-transplant parameters. J Heart Lung Transplant 2004;23:96-104.[Medline]
  13. Thabut G, Vinatier I, Stern JB, Leseche G, Loirat P, Fournier M, et al. Primary graft failure following lung transplantation: predictive factors of mortality. Chest 2002;121:1876-1882.[Medline]
  14. Meyer DM, Bennett LE, Novick RJ, Hosenpud JD. Effect of donor age and ischemic time on intermediate survival and morbidity after lung transplantation. Chest 2000;118:1255-1262.[Medline]
  15. Ciccone AM, Stewart KC, Meyers BF, Guthrie TJ, Battafarano RJ, Trulock EP, et al. Does donor cause of death affect the outcome of lung transplantation?. J Thorac Cardiovasc Surg 2002;123:429-434.[Abstract/Free Full Text]
  16. Remuzzi G, Cravedi P, Perna A, Dimitrov BD, Turturro M, Locatelli G, et al. Long-term outcome of renal transplantation from older donors. N Engl J Med 2006;354:343-352.[Medline]
  17. Moreso F, Seron D, Gil-Vernet S, Riera L, Fulladosa X, Ramos R, et al. Donor age and delayed graft function as predictors of renal allograft survival in rejection-free patients. Nephrol Dial Transplant 1999;14:930-935.[Abstract/Free Full Text]
  18. Ojo AO, Held PJ, Wolfe RA, Merion RM, Leichtman AB, Young EW, et al. Trends in cadaveric organ donation in the United States: 1990-1999. Clin Transpl 2002:105-109.
  19. Canadian Institute for Health Information website. Available at:http://www.hc-sc.gc.ca. Accessed November 2005.

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