Introduction: The scarcity of donor lungs for lung transplant (LTx) drives wait-list mortality for patients with end-stage lung disease. Thus, LTx centres in Australia and Europe have increasingly accepted age-extended criteria donor lungs for LTx - a practice not common in the USA. Nevertheless, long term data on older lung graft outcomes is limited.
Methods: This retrospective analysis included 1114 LTx performed at The Alfred between 2010 and 2024 and compared graft survival (i.e. time to death or re-LTx) outcomes between donors aged < or ≥ 65 years. All potential donors ≥ 65 years had mandatory chest CT assessment.
Results: The mean age of LTx recipients was 52±16 years, 56.5% were male and the mean follow-up was 4.8 ± 3.5 years. Older donors were used in 146/1114 (13%) of all LTx. LTx recipients of older donors were themselves older, 58 ± 11years vs 52 ± 16 years, p<0.001. However, there was no difference in graft survival for older donor lungs (median graft survival < 65 years 8.3 ± 0.5 years vs ≥ 65 years 8.5 ± 0.5 years, p=0.255, or < 70 years 8.5 ± 0.6 years vs ≥ 70 years 8.5 ± 0.5 years, p=0.186). Additionally, there was no difference in the cause of death (malignancy vs infection vs CLAD vs other, p=0.438). Re-LTx occurred more often in the younger donor group (5.2% vs 1.4%, p=0.043).
Conclusion: Contrary to earlier US reports, graft survival is similar for lungs retrieved from donors < 65, compared with donors ≥ 65 (or even 70 years). Appropriately assessed age-extended lungs should be routinely considered for LTx.