Experience of the Reina Sofia Hospital in lung transplantation from donors older than forty years.

INTRODUCTION

The shortage of suitable donors for lung transplantation (LT) has led to liberalization of criteria for donor selection. This study evaluated the outcomes of LT among a subset of patients receiving organs from standard donors older than 40 years of age.

METHODS

We distributed patients who underwent LTs performed between 1993 and 2007 into 2 groups: Group A, donors younger than 40 years; and Group B, donors 40 years of age or older. We compared donor and recipient preoperative, operative, and recipient postoperative factors by univariate analyses.

RESULTS

We reviewed 255 consecutive LT patients: Group A, 198 patients (78%); and Group B, 57 patients (22%). Donors from Group A showed longer intubation times (43 hours vs 34 hours; P = .026) and a better PaO2/FiO2 ratio (477 vs 454 mm Hg; P = .020), with no differences in other donor variables. Among patients dying of primary graft failure, 20% were from Group B versus 5.6% from Group A (P = .04). There were no differences in mortality or other postoperative variables. Survival rates did not differ between groups (70%, 62%, 52%, and 45% in Group A vs 60%, 45%, 45%, and 20% in Group B at 1, 3, 5, and 10 years, respectively; P = .13).

CONCLUSION

The use of ideal donors older than 40 years of age might be related to a higher incidence of primary graft failure. However, long-term survival is similar to that of recipients from younger donors.