Effect of Donor Age and Ischemic Time on Intermediate Survival and Morbidity After Lung Transplantation

Pressure to expand the donor poolhas required the use of lungs from older donors or from more-distantprocurement areas. The long-term consequences of this policy have notyet been fully addressed. The effect of donor age and donor ischemictime on intermediate survival and important secondary end points afterlung transplantation was therefore examined. A cohort of 1,800 lung transplant recipients with complete 2-yearfollow-up, operated on in the United States between April 1, 1993, andMarch 31, 1996, was studied to assess survival. For analysis ofsecondary end points, the cohort was limited to 1,450 patients. Donor age when analyzed independently did notsignificantly affect intermediate survival (p = 0.4). Secondary endpoints were also not affected by age, with the exception of theincidence of hospitalization for rejection 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 ischemic timeindependently on survival in the multivariate analysis. Similarly, whenthe interaction between ischemic time and donor age was examined in allof the multivariate models, none of the secondary end points were foundto be significantly influenced. However, the combined interactionbetween donor age and ischemia time demonstrated a significantly worsesurvival at 2 years (p = 0.02) with donor age of > 50 years anddonor ischemic time > 7 h. Donor ageand donor ischemic time did not independently influence survival orimportant secondary end points after lung transplantation. However,intermediate-term survival was affected by the use of older donors whencombined with a prolonged ischemic time. The impact of this combinationshould be considered when attempting to expand the donorpool.