Choi Ashley Y, Jawitz Oliver K, Raman Vignesh, Halpern Samantha E, Haney John C, Klapper Jacob A, Hartwig Matthew G
School of Medicine, Duke University, Durham, North Carolina.
Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina.
Ann Thorac Surg. 2020 Nov;110(5):1683-1690. doi: 10.1016/j.athoracsur.2020.04.050. Epub 2020 May 31.
Patterns of use of older donor lungs within this previously underused donor population are poorly characterized. This study examined factors associated with the use of older donor lung allografts and factors associated with survival in recipients of these lungs.
Adult donors in the United Network for Organ Sharing registry who donated 1 or more organs for transplantation between 2006 and 2018 were analyzed and stratified into older (age >55 years) and younger (age ≤55 years) cohorts. Multivariable logistic and Cox regression were used to identify factors associated with transplantation of older donor lungs and factors associated with survival, respectively.
Overall, 202,477 donors were included and stratified by age (older, 40,406 [20%]; younger, 162,071 [80%]). Compared with younger donors, older donors had an increased rate of consent for donation not requested by organ procurement organizations (7.5% vs 1.7%). Donor factors significantly associated with decreased lung use included male sex, increasing donor age, black race, Hispanic ethnicity, cigarette use, cocaine use, donation after circulatory death status, and PaO/FiO (P/F ratio) lower than 350. In recipients of older donor lungs, increasing donor age (hazard ratio [HR], 1.03; 95% confidence interval [CI], 1.01, 1.05), recipient age 47 years or older (HR 1.03; 95% CI, 1.02, 1.04), and male sex (HR, 1.19; 95% CI, 1.02, 1.39) portended worse survival.
Barriers in consenting practices, concerns about organ function, and recipient survival prevent the widespread use of aged allografts for lung transplantation. Better understanding of factors associated with worse outcomes of older donors and modification of organ procurement organization consenting practices may increase the use of these higher-risk donor organs.
在这个先前未得到充分利用的供体群体中，老年供肺的使用模式特征尚不明确。本研究调查了与老年供肺移植相关的因素以及这些肺移植受者的生存相关因素。
对器官共享联合网络登记处2006年至2018年间捐献1个或更多器官用于移植的成年供体进行分析，并分为老年（年龄>55岁）和年轻（年龄≤55岁）队列。多变量逻辑回归和Cox回归分别用于确定与老年供肺移植相关的因素和与生存相关的因素。
总体而言，纳入了202477名供体，并按年龄分层（老年，40406名[20%]；年轻，162071名[80%]）。与年轻供体相比，老年供体对器官获取组织未要求的捐赠同意率更高（7.5%对1.7%）。与肺使用减少显著相关的供体因素包括男性、供体年龄增加、黑人种族、西班牙裔、吸烟、使用可卡因、循环死亡状态下的捐赠以及低于350的动脉血氧分压/吸入氧分数（P/F比值）。在老年供肺受者中，供体年龄增加（风险比[HR]，1.03；95%置信区间[CI]，1.01，1.05）、受者年龄47岁及以上（HR 1.03；95% CI，1.02，1.04）以及男性（HR，1.19；95% CI，1.02，1.39）预示着生存情况更差。
同意捐赠的实践障碍、对器官功能的担忧以及受者生存情况阻碍了老年同种异体移植物在肺移植中的广泛使用。更好地了解与老年供体不良结局相关的因素并改进器官获取组织的同意捐赠实践可能会增加这些高风险供体器官的使用。
