Effect of donor age and ischemic time on intermediate survival and morbidity after lung transplantation

Background: Pressure to expand the donor pool has required the use of lungs from older donors or from more-distant procurement areas, The long-term co nsequences of this policy have not yet been fully addressed. The effect of donor age and donor ischemic time on intermediate survival and important se condary end points after lung transplantation was therefore examined. Methods: A cohort of 1,800 lung transplant recipients with complete e-year follow-up, operated on in the United States between April 1, 1993, and Marc h 31, 1996, was studied to assess survival, For analysis of secondary end p oints, the cohort was limited to 1,450 patients. Results: Donor age when analyzed independently did not significantly affect intermediate survival (p = 0.4), Secondary end points were also not affect ed by age, with the exception of the incidence of hospitalization for rejec tion in the univariate analysis (p = 0.02) and in the multivariate analysis (p = 0.04), Moreover, there was not a significant impact of donor age or i schemic time independently on survival in the multivariate analysis. Simila rly, when the interaction between ischemic time and donor age was examined in all of the multivariate models. none of the secondary end points were fo und to be significantly influenced. However, the combined interaction betwe en donor age and ischemia time demonstrated a significantly worse survival at 2 years (p = 0.02) with donor age of >50 years and donor ischemic time > 7 h. Conclusions: Donor age and donor ischemic time did not independently influe nce survival or important secondary end points after lung transplantation. However, intermediate-term survival was affected by the use of older donors when combined with a prolonged ischemic time. The impact of this combinati on should be considered when attempting to expand the donor pool.