Demographic ageing and its influence on current lung transplant practice

Abstract

Hall and colleagues, from the University of Florida in Gainesville (USA) report in a recent issue of The Annals of Thoracic Surgery (1), an interesting analysis on the effect of both donor and recipient age on lung transplant outcomes. For their purpose, they reviewed the United Network for Organ Sharing (UNOS) database, recruiting all adult recipients transplanted between 2005 and 2015. Interestingly, on univariable analyses they observed that donors older than 60 years as well as recipients older than 70 years had the worst survival. Moreover, after analysing the combination of donor and recipient ages, they observed that only recipients aged between 60 and 69 years behaved worse when receiving donors over 60 years. Furthermore, any other negative impact on survival was found when other donor/recipient age combinations were investigated. These poor results of older donors are likely to be associated to the advanced age of the recipients to whom older donors are allocated, mainly receiving single lung transplants. However, in an additional propensity score matching analysis adjusting for relevant covariates, the authors found that when survival in recipients between 60 and 69 years was compared with those receiving younger donors versus donors older than 60 years, differences in recipient survival disappeared. The authors concluded that, given the growing population of recipients older than 60 years, the use of older donors in these patients is not related to higher mortality rates.