BACKGROUND Although the demand for allografts continuously surpasses the supply, the majority of lungs offered for transplant are declined based on various factors, including donor age. This in turn sustains the wait-list mortality of patients with end-stage pulmonary disease. METHODS In this single-center, observational cohort study, we investigated the impact of donor age on graft survival. We additionally compared our center's data to data reported to the International Society for Heart and Lung Transplantation (ISHLT) Thoracic Organ Transplant Registry. Kaplan-Meier method was used to describe overall graft survival. Multivariate Cox proportional hazards regression was used to assess clinical features associated with graft loss. RESULTS Between January 2010 and December 2023, Alfred performed 1,101 single and double lung transplants and the combined ISHLT cohort totaled 32,200 transplants. At Alfred, grafts originating from donors ≥65 years were used in 13.3% of lung transplant cases and univariate analysis showed no impact of donor age ≥65 on graft survival (hazard ratio [HR] 0.86, p = 0.34). In the combined cohort, North America had a lower proportion of donors aged ≥65 years compared to Europe and the Alfred (2.4% vs 9.8% vs 13.3%, p < 0.001). The univariate analysis showed a negative impact of donor age ≥65 on graft survival (HR 1.16, p < 0.001). However, this did not hold in a multivariate model (HR 1.06, p = 0.298) when adjusted for center experience and recipient characteristics. CONCLUSIONS Donor age might impact outcomes to a lesser degree than previously suggested. Therefore, appropriately assessed age-extended lungs should be routinely considered for lung transplantation.

中文翻译：

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供体年龄 ≥65 岁对大型肺移植队列移植物存活率的影响。


背景 尽管对同种异体移植物的需求不断超过供应，但大多数用于移植的肺都因各种因素而下降，包括供体年龄。这反过来又维持了终末期肺病患者的等待名单死亡率。方法 在这项单中心、观察性队列研究中，我们调查了供体年龄对移植物存活率的影响。我们还将我们中心的数据与向国际心肺移植学会 （ISHLT） 胸部器官移植登记处报告的数据进行了比较。采用 Kaplan-Meier 方法描述移植物总存活率。多变量 Cox 比例风险回归用于评估与移植物丢失相关的临床特征。结果在 2010 年 1 月至 2023 年 12 月期间，Alfred 进行了 1,101 例单肺和双肺移植手术，ISHLT 联合队列共进行了 32,200 例移植手术。在 Alfred，13.3% 的肺移植病例使用了源自 ≥65 岁供体的移植物，单变量分析显示供体年龄 ≥65 岁对移植物存活没有影响 （风险比 [HR] 0.86，p = 0.34）。在联合队列中，与欧洲和阿尔弗雷德相比，北美 ≥65 岁的捐献者比例较低 （2.4% vs 9.8% vs 13.3%，p < 0.001）。单变量分析显示供体年龄 ≥65 岁对移植物存活率有负面影响 （HR 1.16，p < 0.001）。然而，当根据中心体验和接受者特征进行调整时，这在多变量模型 （HR 1.06，p = 0.298） 中并不成立。结论 供体年龄对结局的影响程度可能小于先前建议的。因此，应常规考虑对年龄延长的肺进行肺移植。