LAUSR

OBJECTIVE To describe our experience with lung transplantation (LTx) from donors ≥70 years and compare short- and long-term outcome to a propensity-matched cohort of donors <70 years. SUMMARY BACKGROUND DATA While extended-criteria donors have been widely used to enlarge the donor pool, the experience with LTx from older donors (≥70 y) remains limited. METHODS All single-center bilateral LTx between 2010 and 2020 were retrospectively analyzed. Matching (1:1) was performed for donor (type, sex, smoking history, X-ray abnormalities, PaO2/FiO2 ratio, time on ventilator) and recipient characteristics (age, sex, LTx indication, perioperative extra-corporeal life support, CMV mismatch). Primary graft dysfunction (PGD) grade-3, five-year patient and chronic lung allograft dysfunction (CLAD)-free survival were analyzed. RESULTS Out of 647 bilateral LTx, 69 were performed from donors ≥70 years. Mean age in the older donor cohort was 74 years (range 70-84 y) versus 49 years (range 12-69 y) in the matched younger group. No significant differences were observed in length of ventilatory support, ICU- or hospital-stay. PGD-3 was 26% in the older group versus 29% in younger donor recipients (P=0.85). Re-intervention rate was comparable (29% vs. 16%; P=0.10). Follow-up bronchoscopy revealed no difference in bronchial anastomotic complications (P=1.00). Five-year patient and CLAD-free survival were 73.6% versus 73.1% (P=0.72) and 51.5% versus 59.2% (P=0.41), respectively. CONCLUSIONS LTx from selected donors ≥70 years is feasible and safe, yielding comparable short- and long-term outcome in a propensity-matched analysis with younger donors (<70 y).