Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida College of Medicine, Gainesville, Florida.
Division of Transplant Nephrology, University of Florida College of Medicine, Gainesville, Florida.
Ann Thorac Surg. 2019 Mar;107(3):868-876. doi: 10.1016/j.athoracsur.2018.09.066. Epub 2018 Nov 13.
Lung transplantation for patients with end-stage lung disease continues to grow worldwide. Increasing demand for this therapy generates significant waitlist mortality, indicating that alternative sources of donor lungs, such as older donors, are needed. The effect of the donor-recipient age relationship on outcomes remains unclear.
A retrospective review of the United Network for Organ Sharing Standard Transplant Analysis and Research database was performed for adult lung recipients from 2005 to 2015. Variables examined included donor age, recipient age, listing diagnosis, episodes of acute cellular rejection in the first year, and survival. Both donors and recipients were stratified according to age ranges. Survival was compared with the log-rank test. Propensity score matching was done stratifying donors younger than 60 years versus older than 60 years for the recipient population of 60 to 69 years.
From May 2005 to February 2015, 15,844 patients underwent lung transplantation. Unadjusted comparisons of donor-to-recipient age showed that older donor age appeared to be more relevant for recipients 60 to 69 years old (p = 0.002). Nevertheless, when propensity matching was done based on relevant covariates for recipients in this age range by donors younger or older than 60 years, there were no differences in survival.
Our results suggest that even though donor and recipient age may be important in lung transplantation, the interplay between donor and recipient age alone is not an independent determinant of survival. Careful selection of lungs from donors older than 60 years old should be exercised, taking into consideration the totality of donor demographics and risk factors rather than dismissing lungs based on advanced age alone.
肺移植术用于治疗终末期肺病患者的全球应用仍在不断增加。肺移植术需求的增长导致了大量的等待名单死亡病例，这表明需要寻找其他供体肺源，如老年供体。供体和受体年龄关系对预后的影响仍不明确。
对 2005 年至 2015 年间美国器官共享联合网络标准移植分析和研究数据库中的成人肺移植受者进行回顾性分析。检查的变量包括供体年龄、受体年龄、列表诊断、移植后 1 年内的急性细胞排斥反应发作次数以及生存率。根据年龄范围对供体和受体进行分层。采用 Log-rank 检验比较生存率。对于 60 至 69 岁的受体人群，在供体年龄小于 60 岁与大于 60 岁的情况下，进行倾向评分匹配分层。
2005 年 5 月至 2015 年 2 月，共有 15844 例患者接受了肺移植。未调整的供体与受体年龄比较显示，对于 60 至 69 岁的受体，供体年龄较大似乎更为相关（p = 0.002）。然而，当根据供体年龄小于或大于 60 岁的相关协变量对该年龄范围内的受体进行倾向评分匹配时，生存率没有差异。
我们的结果表明，尽管供体和受体年龄在肺移植中可能很重要，但供体和受体年龄之间的相互作用本身并不是生存的独立决定因素。对于年龄大于 60 岁的供体，应谨慎选择肺源，应综合考虑供体的人口统计学和危险因素，而不仅仅是因为年龄而放弃肺源。
