The Impact of Donor and Recipient Age: Older Lung Transplant Recipients Do Not Require Younger Lungs

Hall, David J.; Jeng, Eric I.; Gregg, Jon A.; Peláez, Andrés; Emtiazjoo, A.; Chandrashekaran, S.; Pipkin, M.; Beaver, Thomas M.; Machuca, Tiago

doi:10.1016/j.athoracsur.2018.09.066

Cited by 31 publications

(25 citation statements)

References 23 publications

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“…A recent analysis by Hall and colleagues determined that the interplay between donor and recipient age alone was not an independent predictor of survival, particularly in older recipients, and that use of organs from older donors should be considered, taking into account total donor demographics. 29 A further study by Whited and colleagues demonstrated similar findings, in that reasonable transplant outcomes were achieved across all recipient age groups with the use of donors aged over 60 years. 30 In contrast to this, there are still some absolute contraindications to listing patients for transplant that take into consideration potential survival benefit for the individual patient, as well as allocation of a scare resource.…”

Section: Who To List?mentioning

confidence: 67%

Lung transplantation: a review of the optimal strategies for referral and patient selection

Mitchell

Glanville

2019

Ther Adv Respir Dis

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One of the great challenges of lung transplantation is to bridge the dichotomy between supply and demand of donor organs so that the maximum number of potential recipients achieve a meaningful benefit in improvements in survival and quality of life. To achieve this laudable goal is predicated on choosing candidates who are sufficiently unwell, in fact possessing a terminal respiratory illness, but otherwise fit and able to undergo major surgery and a prolonged recuperation and rehabilitation stage combined with ongoing adherence to complex medical therapies. The choice of potential candidate and the timing of that referral is at times perhaps more art than science, but there are a number of solid guidelines for specific illnesses to assist the interested clinician. In this regard, the relationship between the referring clinician and the lung transplant unit is a critical one. It is an ongoing and dynamic process of education and two way communication, which is a marker of the professionalism of a highly performing unit. Lung transplantation is ultimately a team effort where the recipient is the key player. That principle has been enshrined in the three consensus position statements regarding selection criteria for lung and heart-lung transplantation promulgated by the International Society for Heart and Lung Transplantation over the last two decades. During this period, the number of indications for lung transplantation have broadened and the number of contraindications reduced. Risk management is paramount in the pre- and perioperative period to effect early successful outcomes. While it is not the province of this review to reiterate the detailed listing of those factors, an overview position will be developed that describes the rationale and evidence for selected criteria where that exists. Importantly, the authors will attempt to provide an historical and experiential basis for making these important and life-determining decisions. The reviews of this paper are available via the supplementary material section.

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Section: Who To List?mentioning

confidence: 67%

Lung transplantation: a review of the optimal strategies for referral and patient selection

Mitchell

Glanville

2019

Ther Adv Respir Dis

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“…However, this appeared to be different for younger recipients, especially when performing single lung procedures. 8,9 Therefore, defining a strict pattern of use or even acceptable criteria remains a difficult challenge that does not rely on donor age only. The following key points illustrate some general rules applied to older donors in recent years in an effort to increase the donor pool:…”

Section: Extended Criteria For Neurologic Death and Cardiac Death Donor Lungs Donor Agementioning

confidence: 99%

Pushing the Envelope for Donor Lungs

Abdelnour‐Berchtold

Cypel

Keshavjee

2021

Semin Respir Crit Care Med

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The shortage of organ donors remains the major limiting factor in lung transplant, with the number of patients on the waiting list largely exceeding the number of available organ donors. Another issue is the low utilization rate seen in some types of donors. Therefore, novel strategies are continuously being explored to increase the donor pool. Advanced age, smoking history, positive serologies, and size mismatch are common criteria that decrease the rate of use when it comes to organ utilization. Questioning these limitations is one of the purposes of this review. Challenging these limitations by adapting novel donor management strategies could help to increase the rate of suitable lungs for transplantation while still maintaining good outcomes. A second goal is to present the latest advances in organ donation after controlled and uncontrolled cardiac death, and also on how to improve these lungs on ex vivo platforms for assessment and future specific therapies. Finally, pushing the limit of the donor envelope also means reviewing some of the recent improvements made in lung preservation itself, as well as upcoming experimental research fields. In summary, donor lung optimization refers to a global care strategy to increase the total numbers of available allografts, and preserve or improve organ quality without paying the price of early-, mid-, or long-term negative outcomes after transplantation.

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“…The PCC group received a median dose of 703 units pre-CPB and 1405 units post-CPB, for a median total dose of 2108 units. [5][6][7][8][9][10]; P < .001), and packed red cells (5 [3][4][5][6][7] vs 2 [1.25-2.75]; P < .001) and had a shorter time to chest closure (619 vs 548 minutes; P = .008). There were no differences in platelet transfusion, ICU stay or hospital LOS, acute kidney injury (AKI), or mortality.…”

Section: Prothrombin Complex Concentrate (Pcc)mentioning

confidence: 99%

“…Retrospective propensity-matched analysis of donors >60 years old versus those <60 years old in a population of 60- to 69-year-old recipients demonstrated no difference in survival in New Zealand. 5 Unadjusted comparisons of donor age did initially suggest a better survival in the younger donor pool, but when recipient covariates were examined, this survival benefit disappeared. 5 Another study of Nordic centers 6 reported similar findings overall (no difference with older vs younger lungs), except in the CF subgroup of patients, who had a higher mortality when receiving donor lungs aged ≥55 years that persisted after multivariate matching.…”

Section: Lung Transplantationmentioning

confidence: 99%

Noteworthy Literature Published in 2018 for Thoracic Organ Transplantation

Tawil

Adams

Nicoara

et al. 2019

Semin Cardiothorac Vasc Anesth

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Publications of note from 2018 are reviewed for the cardiothoracic transplant anesthesiologist. Strategies to expand the availability of donor organs were highlighted, including improved donor management, accumulating experience with increased-risk donors, ex vivo perfusion techniques, and donation after cardiac death. A number of reports examined posttransplant outcomes, including outcomes other than mortality, with new data-driven risk models. Use of extracorporeal support in cardiothoracic transplantation was a prominent theme. Major changes in adult heart allocation criteria were implemented, aiming to improve objectivity and transparency in the listing process. Frailty and prehabilitation emerged as targets of comprehensive perioperative risk mitigation programs.

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The Impact of Donor and Recipient Age: Older Lung Transplant Recipients Do Not Require Younger Lungs

Cited by 31 publications

References 23 publications

Lung transplantation: a review of the optimal strategies for referral and patient selection

Lung transplantation: a review of the optimal strategies for referral and patient selection

Pushing the Envelope for Donor Lungs

Noteworthy Literature Published in 2018 for Thoracic Organ Transplantation

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