Abstract
Though increasing numbers of patients aged 65+ need life-saving lung transplants, these patients are often denied transplantation due to concerns about the scarcity of donor lungs. Using marginal or extended criteria donor lungs could facilitate the transplantation of elderly patients while alleviating concerns about donor scarcity, and may offer elderly patients survival comparable to that with standard criteria donor lungs. Among 4338 U.S. lung transplant recipients aged 65+ from May 2005-August 2016 in the United Network for Organ Sharing (UNOS) dataset, we assessed survival associated with certain marginal donor factors, compared to the absence of each factor. A multivariable Cox regression model generated a Hazard Ratio for each donor factor, adjusted for the other donor factors and over 20 potential confounders, including transplant center performance. Kaplan-Meier methods were used to obtain survival time quartiles for each group. Among recipients aged 65+, marginal donors characterized by: age 55-64 (HR=1.02, p=0.77), ischemic time 6-8 hours (HR=1.05, p=0.48), smoking history 20+ pack-years (HR=1.07, p=0.37), alcohol use 2+ drinks/day (HR=0.91, p=0.16), and history of cancer (HR=0.74, p=0.09), were each not associated with worse survival than donors without the respective marginal factor. These types of marginal donors were used, respectively, in only 11%, 17%, 10%, 15%, and 2% of recipients aged 65+. However, donors with age 65+ (HR=1.48, p=0.01) or ischemic time 8+ hours (HR=1.35, p=0.01) were associated with worse survival. Several types of marginal donor lungs are not associated with worse survival within recipients aged 65+, yet they are hardly used in this population. Widespread acceptance of these donor types could save lives among the growing population of elderly patients who need lung transplants, without expending standard criteria donor lungs, which are commonly preferred to be utilized in younger recipients.
Published Version
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