Influence of Donor-Recipient Age Mismatch in Young Lung Transplant Recipients

Objectives: Shortage of lung donors necessitates transplantation of lungs from older donors into young recipients. This raises the question whether a high age mismatch between donors and recipients affects the postoperative outcome. Here we investigate outcomes of lung recipients aged between 0 and 50 years whose donors had a high or low age mismatch compared with their respective recipients.

Methods: Records of patients transplanted between 2005 and 2020 and aged between 0 and 50 years (33 ± 12 years) were retrospectively reviewed. Two groups were formed, one including recipients who received organs from donors at least 20 years older (high-mismatch group) and the other group including recipients whose donors were not older than 10 years (low-mismatch group) than the corresponding recipient. Donor smoking status, pO₂ pressure and ventilation time (days) were evaluated. Incidence of Primary Graft Dysfunction grade 3 (PGD 3), ICU stay, ventilation time, perioperative hospital stay, chronic lung allograft dysfunction (CLAD) and graft survival were compared using chi-square test, Mann–Whitney U-test and Kaplan–Meier analysis, respectively.

Result: During the study period, among the 1,722 patients transplanted at our institution, 384 (22.2%) patients were included, 172 (9.9%) patients formed the high-mismatch group, and 212 (12.3%) patients formed the low-mismatch group. Prevalence of donor smoking history was higher in low-mismatch recipients (34 vs. 46%; p = 0.024). PO₂ pressure (390 vs. 405; p = 0.39) and ventilation time (4 vs. 4 days; p = 0.898) prior to organ procurement did not differ between groups. A trend could be observed which shows a higher prevalence of PGD grade 3 after 48 (11 vs. 6%; p = 0.078) and 72 (11 vs. 6%; p = 0.078) hours in high mismatch recipients but without statistical difference. Mechanical ventilation time (14 vs. 14 hours; p = 0.76), ICU stay time (4 vs. 4 days; p = 0.6), and perioperative hospital stay time (25 vs. 24 days; p = 0.17) did not differ between groups. At 5- and 10-year follow-up, overall graft survival (66.3 vs. 67.3%, 54 vs. 48%, p = 0.956), patient survival conditioned to hospital discharge (75.7 vs. 79.2%, 62.9 vs. 64.1%, p = 0.541), and freedom from CLAD (57.6 vs. 62.9%, 47 vs. 38%, p = 0.944) did not differ between the groups.

Conclusion: Age mismatch alone is not a limiting factor regarding acceptance of donor lungs as long as general organ selection criteria are fulfilled.

Publication History

Article published online:
19 February 2021