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

We sought to clarify the effect of donor age as a continuous variable on morbidity and mortality in a single-institution experience. 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. 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. 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.

Holley CT ，Kelly RF ，Shumway SJ ，Brown RZ ，Hertz MI ，Rudser KD ，Quinlan CW ，Cich I ，Loor G ... -  《-》

Outcomes in pediatric lung transplant recipients receiving adult allografts.

Clinical practice in the United States has no restrictions in allocating lungs from adult donors to pediatric recipients. The United Network for Organ Sharing database was queried from 1987 to 2013 for pediatric lung transplant recipients (aged less than 18 years) to assess survival using continuous donor age in years and two donor age groups, ≥ 18 years and > 30 years, for analysis. Of 930 pediatric lung transplants, basic survival analysis identified a mortality hazard when adult lung allografts were transplanted into pediatric recipients; however, multivariate Cox models demonstrated that continuous donor age (hazard ratio [HR] 1.004, 95% confidence interval [CI]: 0.992-1.015, p = 0.524) as well as both categoric age groups, donor 18 years or older (HR 0.967, 95% CI: 0.714-1.309, p = 0.827) and donor older than 30 years (HR 1.168, 95% CI: 0.815-1.673, p = 0.398), did not significantly influence the risk for death. Moreover, propensity score matching analysis confirmed a lack of association of mortality risk with donor age ≥ 18 years (HR 1.129, 95% CI: 0.696-1.831, p = 0.623) and donor age > 30 years (HR 1.050, 95% CI: 0.569-1.937, p = 0.876). Bronchiolitis obliterans syndrome (BOS) was found to be a significant predictor of mortality in univariate analysis (HR 2.033, 95% CI: 1.639-2.521, p < 0.001), but the hazard of BOS did not vary across donor age categories. Adult donor lung allografts appear not to negatively affect survival in pediatric lung transplant recipients when considering confounders, and do not influence survival through an increased hazard for the development of BOS.

Hayes D Jr ，McConnell PI ，Galantowicz M ，Whitson BA ，Tobias JD ，Black SM ... -  《-》

Donor factors are associated with bronchiolitis obliterans syndrome after lung transplantation.

Bronchiolitis obliterans syndrome (BOS) is the major hurdle preventing long-term success in lung transplantation, and is the primary reason for the 50% 5-year survival. Recipient and perioperative risk factors have been investigated in BOS, but less is known about donor factors. Therefore, we investigated what donor factors are important in the development of BOS. We performed a retrospective review of the United Network for Organ Sharing lung transplant database from 1987 to 2008. Lung transplant recipients had yearly follow-up. Donor factors were evaluated for their influence on BOS development. Kaplan-Meier plots of BOS-free survival were compared for each donor factor and a multivariate Cox proportional hazard model for BOS was created with donor factors. A total of 17,222 lung transplant recipients were identified; 6,991 recipients had sufficient follow-up BOS data. Of these recipients 57% (n = 3,984) developed BOS within 5 years. Recipients who received lungs from donors who were younger, without an active pulmonary infection, or those without current tobacco use had longer BOS-free survival. Recipients who received lungs with higher partial pressures of oxygen in arterial blood (Pao(2)) developed more BOS (p < 0.0001). Donor high Pao(2), older age, and current tobacco use were independent predictors of BOS in lung transplant recipients. Donor factors and donor management strategies are important contributors to development of recipient BOS. Identification of these factors may help limit BOS and may identify recipients at high risk. Surprisingly, high Pao(2) in the donor is an independent predictor of BOS development.

Hennessy SA ，Hranjec T ，Swenson BR ，Kozower BD ，Jones DR ，Ailawadi G ，Kron IL ，Lau CL ... -  《-》

Influence of donor-recipient gender mismatch on graft function and survival following lung transplantation.

Alvarez A ，Moreno P ，Illana J ，Espinosa D ，Baamonde C ，Arango E ，Algar FJ ，Salvatierra A ... -  《-》

Gender differences in long-term survival post-transplant: A single-institution analysis in the lung allocation score era.

The purpose of this study was to clarify the significance of recipient gender status on lung transplant outcomes in a large single-institution experience spanning three decades, we analyzed data from all lung transplants performed in our institution since 1986. Kaplan-Meier curves and Cox proportional hazard models were used to evaluate the effect of recipient characteristics on survival and BOS score ≥1-free survival. Logistic regression analysis was used to explore the association of gender with short-term graft function. About 876 lung transplants were performed between 1986 and 2016. Kaplan-Meier survival estimates at 5 years post-transplant for females vs males in the LAS era were 71% vs 58%. In the LAS era, females showed greater unadjusted BOS≥1-free survival than males (35% vs 25%, P=.02) over 5 years. Female gender was the only factor in the LAS era significantly associated with improved adjusted 5-year survival [HR 0.56 (95% CI 0.33, 0.95) P=.03]. Conversely, in the pre-LAS era female gender was not associated with improved survival. Female recipients showed significantly improved survival over 5 years compared to males in the LAS era. A prospective analysis of biologic and immunologic differences is warranted.

Loor G ，Brown R ，Kelly RF ，Rudser KD ，Shumway SJ ，Cich I ，Holley CT ，Quinlan C ，Hertz MI ... -  《-》