1. Outcome of Lung Transplantation Using Grafts From Donors Over 65 Years of Age
- Author
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Régis Renard, Antoine Girault, Alla Avramenko-Bouvier, Arnaud Roussel, Pierre Cerceau, Quentin Pellenc, Vincent Bunel, Cendrine Godet, Gilles Jebrak, Jonathan Messika, Philippe Montravers, Hervé Mal, Yves Castier, Pierre Mordant, Sandrine Boudinet, Sylvain Jean-Baptiste, Dan Longrois, Brice Lortat-Jacob, Alexy Tran Dinh, Malika Hammouda, Lucie Lefèvre, Alice Savary, Agnès Abadie, and Zohra Brouk
- Subjects
Adult ,Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,medicine.medical_treatment ,Primary Graft Dysfunction ,Kaplan-Meier Estimate ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Forced Expiratory Volume ,Internal medicine ,Humans ,Medicine ,Lung transplantation ,Lung ,Donor pool ,Contraindication ,Aged ,Retrospective Studies ,Univariate analysis ,business.industry ,Donor selection ,Graft Survival ,Age Factors ,Retrospective cohort study ,Middle Aged ,Tissue Donors ,medicine.anatomical_structure ,030228 respiratory system ,Case-Control Studies ,Female ,Surgery ,Cardiology and Cardiovascular Medicine ,business ,Lung Transplantation - Abstract
Background The outcome of lung transplantation (LT) is correlated with donor selection. A donor age of 65 years is classically considered a contraindication to lung procurement, and the results of LT from elderly donors remain to be established. Methods This was a retrospective study of a prospectively maintained database including all LTs performed in a single institution (Bichat Hospital, University of Paris, Paris, France) from January 2014 to March 2019. Donors65 years of age or older were included in the elderly group, whereas donors younger than 65 years of age were included in the control group. Results The study group included 241 LTs, including 44 (18%) in the elderly group and 197 (82%) in the control group. As compared with the control group, the elderly group was characterized by the following: donors of shorter stature (166 cm vs 172 cm; P = .04) and with less smoking history (14% vs 40%; P = .001), less bronchoscopic abnormality (20% vs 36%; P = .042), and less chest opacity (16% vs 30%; P = .048); and recipients of shorter stature (166 cm vs 170 cm; P = .04) but with similar diagnoses and gravity. There was no significant difference between the groups in any of the outcomes studied, including primary graft dysfunction, 30-day mortality, 1-year survival, chronic lung allograft dysfunction–free survival, and overall survival. In univariate analysis, the Oto lung donor score was the only factor associated with 1-year survival (score of 6 in alive patients vs score of 7 in dead patients; P = .04); donor age 65 years old or older was not. Conclusions Carefully selected lung grafts from donors 65 years of age or older are associated with outcomes similar to those reported with grafts from younger donors Grafts from older donors thus provide an interesting option to expand the donor pool during a shortage.
- Published
- 2021