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Abstract
<h3>Purpose</h3> Broad trends towards increased thoracic organ transplantation in older recipients are well-described. Additionally, usage of older donor organs is well-accepted by many programs. However, little is known about comparative recipient and donor age demographics, and how these may vary with time. <h3>Methods</h3> Using UNOS/OPTN STAR database for both isolated heart (iHTx) and lung transplantation (iLTx) in adults (1988-2017), annual composition of donor organ pool, recipient waitlist pool, and transplanted patient pool, were characterized with respect to age. The 30-day and 1-year recipient survival outcomes are reported. <h3>Results</h3> For iHTx, temporal trends of increased transplantation of older recipients were observed; increased percentages of recipients aged 60-69 and >70 were identified, with decreases in recipients aged 50-59 and 40-49. These trends were identified in iLTx as well, and were more substantial. In both iHTx and iLTx, by 2017, recipients aged 60-69 accounted for the single largest age range undergoing transplantation. However, analysis of survival outcomes from 2010-17 for iHTx (durable continuous flow mechanical circulatory support era), and from 2006-17 for iLTx (lung allocation score era) revealed reduced 30-day and 1-year survival as a function of recipient age, with exception of iLTx in the age 18-29 group. In contrast, no clear temporal trends were observed with respect to donor heart and lung age demographics. Heart and lung donors aged 18-29 accounted for the single largest age range, followed by ages 30-39. <h3>Conclusion</h3> Cardiothoracic transplantation involves a transference of organs from younger to older individuals, and the extent of this has increased more recently. However, older recipients have decreased short-term survival, which likely translates to diminished long-term survival, given a decreased prospective life expectancy even for healthy older individuals. These findings may have implications for organ allocation policies.
Published Version
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