Optimal Utilization of Donors Aged ≥65 Y in Lung Transplantation to Increase Donor Availability While Maintaining Comparable Posttransplant Outcomes.

Background: Utilizing older donors (≥65 y) in lung transplantation can greatly expand donor availability while potentially maintaining typical survival outcomes in certain subpopulations, such as older recipients, especially compared to survival with single lung transplants (which comprise ~20%-25% of US lung transplants according to recent data).

Methods: This study included US adult lung transplants from 2010 to 2021 in the Scientific Registry for Transplant Recipients. To compare patient groups defined by donor age (D < 65 or D ≥ 65) and transplant type (single or double), stratified by recipient age (R18-39, R40-64, R ≥ 65), Inverse probability of treatment weighting was used to generate Kaplan-Meier survival estimates adjusted for >15 available covariates.

Results: In R40-64, survival with D ≥ 65 double (adjusted median survival [aMS] = 7.1 [3.3-12.0] y, n = 150, P = 0.15) at least equaled survival with D < 65 single (aMS = 5.7 [2.5-10.2] y, n = 2926), whereas D ≥ 65 single use was uncommon (n = 23), and survival was highest with D < 65 double (aMS = 7.7 [3.0-13.4] y, n = 10 934, P < 0.01). In R ≥ 65, survival with D ≥ 65 double (aMS = 5.0 [2.2-10.8] y, n = 90, P = 0.53) or D ≥ 65 single (aMS = 5.3 [1.9-8.4] y, n = 73, P = 0.72) was not significantly different from survival with D < 65 single (aMS = 4.7 [2.1-8.1] y, n = 3913), whereas survival was highest with D < 65 double (aMS = 5.8 [2.0-10.2] y, n = 4209, P < 0.01). In R18-39, D ≥ 65 were uncommon (n = 15).

Conclusions: Among lung recipients aged 40-64 y, donor age ≥65 y double transplants yield survival at least matching that of donor age <65 y single transplants. Among recipients aged ≥65 y, donor age ≥65 y double or single transplants yield survival comparable to that of donor age <65 single transplants. Compared with donor age <65 y double transplants, donor age ≥65 y double transplants had only ≤10 mo shorter adjusted median survival, within recipients aged ≥40 y. Judiciously increasing utilization of donors aged ≥65 y within recipients aged ≥40 y can reduce deaths among patients needing a lung transplant by decreasing donor scarcity, while maintaining favorable posttransplant survival.