Use Of Older Donors Research Articles

Donor to recipient age matching in lung transplantation: A European experience

BackgroundThe age profile of organ donors and patients on lung transplantation (LT) waiting lists have changed over time. In Europe, the donor population has aged much more rapidly than the recipient population, making allocation decisions on lungs from older donors common. In this study we assessed the impact of donor and recipient age discrepancy on LT outcomes in the UK and France. MethodsA retrospective analysis of all adult single or bilateral LT in France and the UK between 2010 and 2021. Recipients were stratified into 3 age groups: young (≤ 30 years), middle-aged (30 to 60) and older (≥60). Their donors were also stratified into 2 groups <60, ≥ 60. Primary graft dysfunction (PGD) rates and recipient survival was compared between matched and mismatched donor and recipient age groups. Propensity matching was employed to minimize covariate imbalances and to improve the internal validity of our results. ResultsOur study cohort was 4,696 lung transplant recipients (LTRs). In young and older LTRs, there was no significant difference in 1 and 5-years post-transplant survival dependent on the age category of the donor. Young LTRs who received older donor grafts had a higher risk of severe grade 3 PGD. ConclusionOur findings show that clinically usable organs from older donors can be utilized safely in LT, even for younger recipients. Further research is needed to assess if the higher rate of PGD3 associated with use of older donors has an effect on long-term outcomes.

Assessment of biological organ age using molecular pathology in pre-transplant kidney biopsies

Organ shortage is a major challenge in kidney transplantation but the use of older donors, often with co-morbidities, is hampered by inconsistent outcomes. Methods of accurately stratifying marginal donor organs by clinical and histological assessment are lacking. To better understand organ variability, we profiled the transcriptomes of 271 kidneys from deceased donors at retrieval. Following correction for biopsy composition, we assessed molecular pathways that associated with delayed, and sub-optimal one-year graft function. Analysis of cortical biopsies identified an adaptive immune gene-rich module that significantly associated with increasing age and worse outcomes. Cellular deconvolution using human kidney reference single cell transcriptomes confirmed an increase in kidney-specific B and T cell signatures, as well as kidney macrophage, myofibroblast and fibroblast gene sets in this module. Surprisingly, innate immune pathway and neutrophil gene signature enrichment was associated with better outcomes. Thus, our work uncovers cellular molecular features of pathological organ ageing, identifiable at kidney retrieval, with translational potential.

Enhancing the usability of older DCD donors through strategic approaches in liver transplantation in the United States.

The use of older donors after circulatory death (DCD) for liver transplantation (LT) has increased over the past decade. This study examined whether outcomes of LT using older DCD (≥50y) have improved with advancements in surgical/perioperative care and normothermic machine perfusion (NMP) technology. A total of 7602 DCD LT cases from the United Network for Organ Sharing database (2003-2022) were reviewed. The impact of older DCD donors on graft survival was assessed using the Kaplan-Meier and HR analyses. In all, 1447 LT cases (19.0%) involved older DCD donors. Although there was a decrease in their use from 2003 to 2014, a resurgence was noted after 2015 and reached 21.9% of all LTs in the last 4 years (2019-2022). Initially, 90-day and 1-year graft survivals for older DCDs were worse than younger DCDs, but this difference decreased over time and there was no statistical difference after 2015. Similarly, HRs for graft loss in older DCD have recently become insignificant. In older DCD LT, NMP usage has increased recently, especially in cases with extended donor-recipient distances, while the median time from asystole to aortic cross-clamp has decreased. Multivariable Cox regression analyses revealed that in the early phase, asystole to cross-clamp time had the highest HR for graft loss in older DCD LT without NMP, while in the later phases, the cold ischemic time (>5.5h) was a significant predictor. LT outcomes using older DCD donors have become comparable to those from young DCD donors, with recent HRs for graft loss becoming insignificant. The strategic approach in the recent period could mitigate risks, including managing cold ischemic time (≤5.5h), reducing asystole to cross-clamp time, and adopting NMP for longer distances. Optimal use of older DCD donors may alleviate the donor shortage.

P.37: Use of older donors in a high-volume pancreas transplant program

P.37: Use of older donors in a high-volume pancreas transplant program

Centurion Livers: Making It to 100 with a Transplant

INTRODUCTION: Liver senescence is not as marked as other solid organs and offers the potential for older allografts to survive for extended periods post-transplant. Livers with a total age of greater than 100 years are known to exist but have not been studied. We examined the characteristics and outcomes of all liver allografts with a cumulative age of greater than 100 years. METHODS: Using the United Network for Organ Sharing (UNOS) STAR file, donor livers with a cumulative age (sum of initial age at transplant plus post-transplant survival) of at least 100 years (CENTURION) were identified from all transplants between 1990 and 2022. Donor/recipient demographic data and outcomes data were collected and compared with all other transplants. RESULTS: Twenty-five of 253,406 transplanted livers met criteria for the CENTURION group. Although significantly older (84.7 vs 38.5 years), CENTURION donors had lower transaminases, lower incidence of diabetes, and fewer donor infections. CENTURION recipients had significantly lower Model for End-stage Liver Disease (MELD) score at the time of transplant. No CENTURION grafts were lost to primary nonfunction or vascular/biliary complications. Interestingly, there was no significant difference in rates of rejection at 12 months. CENTURION outcomes had significantly better allograft (p = 0.0079) and patient survival (p = 0.0077; Fig. 1).Figure 1CONCLUSION: The existence of allografts more than 100 years old is revealing of the dramatic resilience of the liver to senescent events. Further clinical studies to increase understanding and promote use of older donors should be encouraged. Specifically target studies of donor livers with proven longevity could offer new insight into genetic and biological factors inherent in these resilient allografts.

Utilization of elderly donors in liver transplantation for patients with hepatocellular carcinoma: A national retrospective cohort study of China

BackgroundProfound organ shortages worldwide have led to the increased utilization of marginal organs from older individuals. However, the effectiveness of liver transplantation (LT) with organs from elderly donors for patients with hepatocellular carcinoma (HCC) remains controversial. The objective of the current study was to assess the overall survival (OS) and disease-free survival (DFS) of patients with HCC following LT using grafts from deceased donors over 60 years old. Material and methodsPatients with HCC who underwent LT between 2015 and 2018 were identified in the China Liver Transplant Registry database. The overall survival and disease-free survival of older liver donors (OLDs) were compared with those of younger liver donors (YLDs) after propensity score matching. ResultsFrom January 2015 to December 2018, a total of 4971 HCC patients were enrolled in the study according to the screening criteria. The absolute and relative utilization of liver grafts from elderly patients over 60 years for HCC patients increased every year, from 65 (9.3%) in 2015 to 268 (14.5%) in 2018. Disease-free survival (DFS) was significantly lower in HCC patients with elderly donors (both P < 0.05) after propensity score matching. The OLD group had worse DFS than YLD group if patients had tumors beyond the Milan criteria (P < 0.05). ConclusionsThe use of older donors for LT has been growing quickly in the last few years in China. Grafts from older donors can be safely used in HCC recipients with similar OS and comparable perioperative complications. However, further investigation into whether older donor has an impact on recurrence is warranted, especially among those with tumors beyond the Milan criteria.

Expanding Donor Age Criteria: The UK Experience

Transplant programmes are increasingly considering extended criteria donors, including previous smokers and older-age donors. In January 2018, the UK lung donor offering criteria was increased to 74 years (74 years and 364 days) for both DBD and DCD lung donors, where the donor was a life-time non-smoker or had not smoked within the last 10 years. Prior to this, the upper age limit was 64 years for DCD donors and 69 years for DBD donors. This study aims to assess the impact of the UK extended lung donor age criteria on lung utilisation and transplant. Data were obtained from the UK Transplant Registry on all lung offers from DBD donors over 69 years and DCD donors over 64 years ('older donors'), between January 2018 and September 2019. Utilisation was defined as at least one lung accepted and transplanted. One-hundred and seventy-eight donors meeting the criteria for analysis were identified. Of these, 110 proceeded to donation of at least one solid organ. Lungs were offered from 52 potential DBD donors aged 70-74 years and 126 potential DCD donors aged 65-74 years. Six (11.5%) of the 52 DBD lungs were transplanted and 2 (1.6%) of the 126 DCD lungs were transplanted. Recipient age ranged from 50-66 years. One recipient was listed as urgent at the time of transplant. One-hundred and seventy older donor lung offers were declined. The most common primary reasons for decline recorded were 'past history' (29%), 'poor function' (20%), and 'age' (19%). The cardiothoracic retrieval team attended 28 of the total 178 older donor offers. Although the utilisation rate from older lung donors is low, expanding the donor age criteria in the UK has resulted in an additional 8 transplants, a 1.2% increase. This appears to have benefited the older, non-urgent recipient. Despite the published increases to the donor offering age criteria, 'age' continues to be documented as a reason for organ decline. Further work is required to understand and improve utilisation rates throughout UK lung transplant practice, including the use of older donors. We will continue to review the impact of expanding lung donor age criteria on UK practice, including analysis of recipient outcomes from older age donors.

Survival and Graft Function in Heart Transplant Patients Receiving Adverse Risk Profile Donor Hearts

To determine if use of older donors or donors with adverse cardiovascular risk profile (ACRP) is associated with impaired graft function and adverse longterm outcome in heart transplant recipients.

Improving the outcomes of human immunodeficiency virus/hepatitis C virus–coinfected transplant recipients: The answer is Blowin’ in the wind

Improving the outcomes of human immunodeficiency virus/hepatitis C virus–coinfected transplant recipients: The answer is Blowin’ in the wind

Octogenarian Donors in Liver Transplantation

IntroductionDue to the disparity between the number of patients on the list for liver transplantation and the availability of organs, the use of older donors has become necessary. The aim of this study was to investigate the outcomes of liver transplantation using octogenarian donors. MethodsFrom December 2003 to February 2016, 777 liver transplantations were performed at our institution, 33 of them (4.2%) with donors 80 years old and above. Our policy for the acceptance of these donors is based on preoperative liver function tests, donor hemodynamic stability, and intraoperative normal gross aspect. Octogenarian grafts were deliberately not assigned to retransplantations or to recipients with multiple previous surgical procedures or extensive portal thrombosis. ResultsMean donor age was 82.7 ± 2.1 years, with a range between 80 and 88. Only 12.1% suffered hemodynamic instability during the intensive care unit stay. Three donors (9.1%) had a history of diabetes mellitus. The mean Model for End-Stage Liver Disease score among recipients was 14.7 ± 5.6. Mean cold ischemia time was 302 ± 61 minutes. After a median follow-up of 18.5 months (range 7.5 to 47.5), no graft developed primary nonfunction. We observed hepatic artery thrombosis in 1 patient (3%) and biliary complications in 4 patients (12.5%). There was 1 case of ischemic-type biliary lesion, although it was related to hepatic artery thrombosis. Patient survival at 1 and 3 years was 90.3%, whereas graft survival was 92.6% and 86.4%, respectively. ConclusionsExcellent mid-term results can be obtained after liver transplantation with octogenarian donors with strict donor selection and adequate graft allocation.

Current challenges and future directions for liver transplantation

Liver transplantation is an effective and widely used therapy for several patients with acute and chronic liver diseases. The discrepancy between the number of patients on the waiting list and available donors remains the key issue and is responsible for the high rate of waiting list mortality. The recent news is that the majority of patients with hepatitis C virus related liver disease will be cured by new antivirals therefore we should expect soon a reduction in the need of liver transplantation for these recipients. This review aims to highlight, in two different sections, the main open issues of liver transplantation concerning the current and future strategies to the best use of limited number of organs. The first section cover the strategies to increase the donor pool, discussing the use of older donors, split grafts, living donation and donation after cardiac death and mechanical perfusion systems to improve the preservation of organs before liver transplantation. Challenges in immunosuppressive therapy and operational tolerance induction will be evaluated as potential tools to increase the survival in liver transplant recipients and to reducing the need of re-transplantation. The second section is devoted to the evaluation of possible new indications to liver transplantation, where the availability of organs by implementing the strategies mentioned in the first section and the reduction in the number of waiting transplants for HCV disease is realized. Among these new potential indications for transplantation, the expansion of the Milan criteria for hepatocellular cancer is certainly the most open to question.

Renal Cancer in Recipients of Kidney Transplant.

The aim of our study is to determine characteristics and outcomes of kidney cancer in renal transplant recipients. MEDLINE® database was searched in June 2015 to identify cases of kidney cancer in renal transplant recipients. We include also a new case. Descriptive statistics were used for analysis. Forty-eight (48) recipients reported in 25 papers met the eligibility criteria. The median age was 47 years (range 9-66); 27% were females. Chronic glomerulonephritis, cystic kidney disease and hypertension were common indications for renal transplant. Among donors 24% were females and the median age was 52.5 years (17-73); 62% of kidney cancers were donor-derived. The median interval between transplant and cancer diagnosis was shorter for cancer of recipient versus donor origin (150 vs. 210 days). Clear cell carcinoma was diagnosed in 17%. 25% had metastasis at diagnosis. Kidney explantation or excision was done in 90% and 84% of cases with and without metastasis respectively. The median survival was 72 months. Actuarial 1-year and 5-year survival rates were 73.4% and 55.1% respectively. Among the recipients from 7 donors who subsequently developed malignancy, 57% were dead within a year. Kidney transplant recipients have a small risk of kidney cancer, which affects younger patients and occurs within a year of transplant, likely due to immunosuppression. Whether the use of older donors may increase the likelihood needs further investigation. The presence of metastasis, explantation or excision of affected kidney and development of cancer in donors predict outcomes. The results may guide patient education and informed decision-making.

The 2016 International Society for Heart Lung Transplantation listing criteria for heart transplantation: A 10-year update

Mandeep R. Mehra, MD (Chair), Charles E. Canter, MD, Margaret M. Hannan, MD, Marc J. Semigran, MD, Patricia A. Uber, PharmD, David A. Baran, MD, Lara Danziger-Isakov, MD, MPH, James K. Kirklin, MD, Richard Kirk, MD, Sudhir S. Kushwaha, MD, Lars H. Lund, MD, PhD, Luciano Potena, MD, PhD, Heather J. Ross, MD, David O. Taylor, MD, Erik A.M. Verschuuren, MD, PhD, Andreas Zuckermann, MD and on behalf of the International Society for Heart Lung Transplantation (ISHLT) Infectious Diseases, Pediatric and Heart Failure and Transplantation Councils

Related Nonmyeloablative Haploidentical (mini-haplo) Blood or Marrow Transplantation (BMT) with High-Dose Post-Transplant Cyclophosphmade (PTCy) for Acute Myeloid Leukemia (AML): Donor Age Impacts Outcome

IntroductionAllogeneic BMT is often the only curative option for poor-risk AML. Not only does mismatched BMT circumvent the limited availability of HLA matched donors, but it also allows a wider choice of potential donors. We report an analysis of mini-haplo BMT in 93 patients with high-risk AML. In light of emerging data regarding the influence of donor age on outcome of BMT, we specifically studied the impact of donor age on outcome.Methods We conducted a retrospective review of all adult patients at Johns Hopkins, who received a mini-haplo BMT for AML between January of 2003 and February of 2013. Patients received Cy (14.5 mg/kg/day IV D -6,-5), fludarabine (30mg/mg2/day IV D -6 to -2), and 200 cGy total body irradiation on day -1. GVHD prophylaxis was PTCy (50 mg/kg D 3, 4), mycophenolate mofetil, and tacrolimus. Progression-free (PFS) and overall survival (OS) were evaluated based on Kaplan-Meier method. The cumulative incidence of GVHD and non-relapse mortality (NRM) were assessed via Gray's approach..ResultsThe median age of the 93 AML patients was 54 (range 24-73). For the 47 patients transplanted in CR1, the median time to BMT from CR1 was 84 (range 11-347) days. Median follow-up was 44 (range 5-117) months. Successful engraftment with sustained donor chimerism was achieved in 80 of 89 evaluable patients by day 60; two additional patients experienced secondary graft failure. These 11patients who developed graft failure had donors who were older, with a median age of 49 (range 35-63) versus 38 (range 14-68) years (p=0.03), and they received allografts with significantly fewer CD34+ cells, with a median of 2.5x106/kg compared to 4.5x106 cells/kg (p=0.01). The 13 allografts with ≤ 2.5x106 CD34+ cells/kg were associated with 6 of the primary graft failures compared to only 5 graft failures in the 80 patients receiving > 2.5x106 CD34+ cells/kg (p=0.0004). Moreover, the donors of the 13 allografts with ≤ 2.5x106 CD34+ cells/kg had a median age of 52 compared to age 39 for donors of the 80 grafts with > 2.5x106 CD34+ cells/kg (p=0.04). The overall cumulative incidence (CI) of grade II-IV and III-IV aGVHD and cGVHD was 24% (95% CI 15-33%), 8% (2-13%), and 17% (9-25%), respectively. The CI of NRM was 11% (4-17%). The overall CI of relapse was 54% (95%CI 43-65%). The 4-year actuarial OS and PFS were 47% (95% CI 37-59%) and 35% (95%CI 26-48%) (Fig 1). Patient age did not have a significant impact on survival. However, there was a trend toward better survival with younger donors. For patients with donors ≤ 55 years, the median OS was 63 (range 1-118) months compared to 13 (range 1-65) months (p=0.14) (Fig 2).DiscussionMini-haplo BMT offers a potentially curative option for poor-risk AML patients lacking matched donors. GVHD and NRM rates were low. The time to BMT in our patients was similar to those reported for matched sibling donors (Walter, et al, Blood. 2013; 122: 1813-1821) and shorter than those for MUD transplants, (Rollig, et al, JCO. 2015; 33: 403-410), an important consideration because over one-third of pts with high-risk AML relapse within 4 months of initial therapy. Graft failure, a concern with mismatched BMT, appears to be in part related to donor age, with older donors providing inferior quality allografts. Survival was also inferior with the use of older donors. Our data strongly suggest that no AML patient in need of BMT should be denied the procedure for lack of a suitable donor. Moreover, the use of mismatched donors allows donor selection based on donor characteristics, such as age, that have the potential to improve outcomes. [Display omitted] [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

(23) - Shorter Cold Ischemic Time in Older Donors Post-Heart Transplant Appears to Be Protective

The use of older donors in heart transplant (≥50 years old) has been reported to have less good outcome compared to younger donors (<50 years old). These older donors may have preexisting coronary artery disease, and have risk factors including hypertension, diabetes and hyperlipidemia. It has been postulated that the use of older donors with relatively short cold ischemic times may have improved outcomes. Therefore, we sought to answer this question by evaluating our older donors and cold ischemic time. Between 1994 and 2010, we evaluated 748 heart transplant patients and divided them into those who received donor hearts ≥50 years old and <50 years old. Patients were further divided into those who had a cold ischemic time of <120 minutes (short), 120-140 minutes (medium), and 240 minutes (long). Endpoints included 5-year actuarial graft survival, freedom from cardiac allograft vasculopathy (CAV), freedom from non-fatal major adverse cardiac events (NF-MACE: myocardial infarction, new congestive heart failure, percutaneous coronary intervention/angioplasty, pacemaker/ICD insertion and stroke) and freedom from 1-year treated rejection. Patients who received older donor hearts with short ischemic times appeared to have comparable long-term outcomes to patients who received a younger donor heart with short ischemic times. Patients who received an older donor heart with a cold ischemic time of 120-240 minutes and >240 minutes had poorer outcomes compared to patients who received a younger donor heart in each time group (see table). A shortened cold ischemic time appears to confer better long-term graft survival in heart transplant patients with older donors. This will be of value in selection of older donors.

Heart transplantation using allografts from older donors: Multicenter study results

The lengthy waiting time for heart transplantation is associated with high mortality. To increase the number of donors, new strategies have emerged, including the use of hearts from donors ≥50 years old. However, this practice remains controversial. The aim of this study was to evaluate outcomes of patients receiving heart transplants from older donors. We retrospectively analyzed 2,102 consecutive heart transplants in 8 Spanish hospitals from 1998 to 2010. Acute and overall mortality were compared in patients with grafts from donors ≥50 years old versus grafts from younger donors. There were 1,758 (84%) transplanted grafts from donors < 50 years old (Group I) and 344 (16%) from donors ≥50 years old (Group II). Group I had more male donors than Group II (71% vs. 57%, p = 0.0001). The incidence of cardiovascular risk factors was higher in older donors. There were no differences in acute mortality or acute rejection episodes between the 2 groups. Global mortality was higher in Group II (rate ratio, 1.40; 95% confidence interval, 1.18-1.67; p = 0.001) than in Group I. After adjusting for donor cause of death, donor smoking history, recipient age, induction therapy, and cyclosporine therapy, the differences lost significance. Group II had a higher incidence of coronary allograft vasculopathy at 5 years (rate ratio, 1.67; 95% confidence interval, 1.22-2.27; p = 0.001). There were no differences in acute and overall mortality after adjusting for confounding factors. However, there was a midterm increased risk of coronary allograft vasculopathy with the use of older donors. Careful selection of recipients and close monitoring of coronary allograft vasculopathy are warranted in these patients.

Association Between Liver Transplant Center Performance Evaluations and Transplant Volume

There has been increased oversight of transplant centers and stagnation in liver transplantation nationally in recent years. We hypothesized that centers that received low performance (LP) evaluations were more likely to alter protocols, resulting in reduced rates of transplants and patients placed on the waiting list. We evaluated the association of LP evaluations and transplant activity among liver transplant centers in the United States using national Scientific Registry of Transplant Recipients data (January 2007 to July 2012). We compared the average change in recipient and candidate volume and donor and patient characteristics based on whether the centers received LP evaluations. Of 92 eligible centers, 27 (29%) received at least one LP evaluation. Centers without an LP evaluation (n = 65) had an average increase of 9.3 transplants and 14.9 candidates while LP centers had an average decrease of 39.9 transplants (p < 0.01) and 67.3 candidates (p < 0.01). LP centers reduced the use of older donors, donations with longer cold ischemia, and donations after cardiac death (p-values < 0.01). There was no association between the change in transplant volume and measured performance (R(2) = 0.002, p = 0.91). Findings indicate a strong association between performance evaluations and changes in candidate listings and transplants among liver transplant centers, with no measurable improvement in outcomes associated with reduction in transplant volume.

Long-Term Safety of Living Kidney Donors Aged 60 and Older

In Japan, kidney transplantation procedures are usually dependent upon live donors. As the recipient ages have been increasing, so has there been a corollary increase in the age of the live donors. Despite this being controversial, the use of older donors is becoming increasingly common. The purpose of our study was to evaluate the long-term safety of accepting older living kidney donors and graft survival rates. We retrospectively analyzed long-term donor outcomes for consecutive patients at our institution between January 1990 and December 2011. Older live kidney donors were defined as ≥60 years and younger live kidney donors were defined as <60 years old. Thirty-three were ≥60 years and 55 donors were <60 years. The mean follow-up term was 7 years and 4 months. Predonation, older donors had a lower estimated glomerular filtration rate (eGFR) level (77.1 ± 9.5 mL/min/1.73 m2) than younger donors (85.8 ± 14.6 mL/min/1.73 m2; P < .01). More older donors had a history of hypertension (42.4% vs 9.1%; P < .01). In both groups, eGFR levels decreased about 40% immediately after nephrectomy. Residual renal function though was stable on long-term follow-up. The incidence of de novo hypertension and proteinuria after nephrectomy was not different between the 2 groups. In older donors, there were no perioperative complications that required extended hospital stays. Graft survival over a period of 10 years was similar in both groups. In our study, donor age had no influence on the deterioration of renal function after nephrectomy. Regardless of age, careful evaluation and follow-up are important for the donor's long-term safety after donation.

Technical feasibility of liver transplantation without cold storage

The success of liver transplantation (LT) is accompanied by an increased need for organs. The wider use of older donors and marginal organs with risk factors such as steatosis has lead to a new interest to improve the outcome with marginal organs. We herewith report a novel technique for LT with in situ preparation and immediate warm-ischemia liver transplantation (WI-LT). The aim of our study was to demonstrate the technical feasibility and report the transplant course. Six patients underwent WI-LT at our institution. Hepatectomies during procurement and LT were both performed in parallel by different surgical teams. Technical factors and postoperative allograft function were analyzed. All six WI-LTs were performed without intraoperative complications with a mean warm-ischemia time (WIT) of 29.0min. No patient developed primary non-function or required retransplantation. Mean alanine aminotransferase (194.0 ± 170.4U/l) and aspartate aminotransferase (316.3 ± 222.1U/l) values on the first postoperative day were low, indicating a low ischemia/reperfusion injury and an excellent liver function. These results demonstrate that WI-LT is a safe and technically feasible approach for LT with possibly reduced IRI and an excellent postoperative allograft quality. WI-LT may therefore be considered in individual patients especially with extended criteria donors to eventually improve postoperative allograft quality.

Mobilization and engraftment of peripheral blood stem cells in healthy related donors >55 years old

Background aimsThe increasing scarcity of young related donors has led to the use of older donors for related allogeneic hematopoietic stem cell transplantation (HSCT). This study analyzed the influence of age on the results of mobilization of peripheral blood stem cells (PBSCs) in healthy donors as well as on the engraftment and outcome of HSCT. MethodsA retrospective analysis from a single center was performed comparing the results of PBSC mobilization from related healthy donors according to their age. ResultsThe study included 133 consecutive related donors. The median age was 50 years (range, 4–77 years); 70 (53%) donors were males, and 44 (33%) were >55 years old. All donors were mobilized with granulocyte colony-stimulating factor for 5 days. The peak CD34+ cell count in peripheral blood was higher in younger than in older donors (median, 90.5 CD34+ cells/μL [range, 18–240 CD34+ cells/μL] versus 72 CD34+ cells/μL [range, 20–172.5 CD34+ cells/μL], P = 0.008). The volume processed was lower in younger than in older donors (16,131 mL [range, 4424–36,906 mL] versus 18,653 mL [range, 10,003–26,261 mL], P = 0.002) with similar CD34+ cells collected (579.3 × 106 cells [range, 135.14 × 106–1557.24 × 106 cells] versus 513.69 × 106 cells [range, 149.81 × 106–1290 × 106 cells], P = 0.844). There were no differences in time to recovery of neutrophils and platelets or in the incidences of acute and chronic graft-versus-host disease, overall survival, non-relapse mortality and relapse incidence. ConclusionsDonors >55 years old mobilized fewer CD34+ cells and required a greater volume to collect a similar number of CD34+ cells. The outcome of HSCT was not influenced by donor age. Donor age should not be a limitation for related allogeneic HSCT.