Impact of donors aged 60 years or more on outcome after lung transplantation: Results of an 11-year single-center experience

Objective: We examined the outcome of lung transplantation with the use of donors aged 60 years or more. Methods: From May 1994 to May 2005, 467 lung transplants were performed at our institution. A total of 60 recipients received lungs from donors aged 60 years or more (range 60-77 years, median 65 years), whereas 407 recipients received lungs from younger donors (range 9-59, median 39 years). Results: A total of 48 patients (10%) died within 30 days of surgery: 10 (17%) in the older donor group versus 38 (9%) in the younger donor group (P = .08). The operative mortality varied with the underlying lung disease and was higher in recipients presenting with pulmonary hypertension and pulmonary fibrosis than with emphysema or cystic fibrosis. A total of 210 patients died after a median follow-up of 25 months (range 0-136 months). The overall 5- and 10-year survivals were 57% and 38%, respectively. However, the 10-year survival tended to be worse in the older donor group (16% vs 39% in the younger donor group, P = .07). Bronchiolitis obliterans syndrome was the predominant cause of death in recipients of older donors who survived for more than 90 days after surgery (11/17, 65% vs 45/132, 34% in recipients of younger donors surviving for > 90 days after surgery, P = .01). Conclusions: Given the lack of organ donors, lungs from donors aged 60 years or more should be considered for transplantation. However, the use of donors aged 60 years or more is associated with a lower 10-year survival, and bronchiolitis obliterans syndrome plays a significant role as the cause of late death.