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.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
19 February 2021