Impact of donors aged 60 years or more on outcome after lung transplantation: Results of an 11-year single-center experience
Impact of donors aged 60 years or more on outcome after lung transplantation: Results of an 11-year single-center experience
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DOI：
10.1016/j.jtcvs.2006.09.054
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发表时间：
2007-02-01
影响因子：
6
通讯作者：
Keshavjee, Shaf
中科院分区：
文献类型：
--
作者：
de Perrot, Marc;Waddell, Thomas K.;Keshavjee, Shaf
目的：我们研究的结果，肺移植与使用的供体年龄在60岁或以上。方法：从1994年5月至2005年5月，467例肺移植在我们的机构进行。共有60名受体接受了60岁或以上捐赠者的肺（范围60-77岁，中位数65岁），而407名受者接受了来自年轻供体的肺结果：共有48名患者（10%）在手术后30天内死亡：老年供体组10例（17%），年轻供体组38例（9%）（P = 0.08）。手术死亡率因潜在肺部疾病而异，肺动脉高压和肺纤维化患者的手术死亡率高于肺气肿或囊性纤维化患者。在中位随访25个月（范围0-136个月）后，共有210例患者死亡。总的5年和10年生存率分别为57%和38%。然而，老年供体组的10年生存率往往更差（16% vs年轻供体组的39%，P = 0.07）。闭塞性细支气管炎综合征是手术后存活超过90天的老年供体受者的主要死亡原因（11/17，65% vs 45/132，34%的年轻供体受者术后存活> 90天，P = .01）。由于缺乏器官捐献者，60岁或60岁以上的捐献者的肺应该考虑移植。然而，使用60岁或以上的捐献者与10年生存率较低有关，而闭塞性细支气管炎综合征作为晚期死亡的原因发挥着重要作用。
Objective: We examined the outcome of lung transplantation with the use of donors aged 60 years or more.Methods: From May 1994 to May 2005, 467 lung transplants were performed at our institution. A total of 60 recipients received lungs from donors aged 60 years or more (range 60-77 years, median 65 years), whereas 407 recipients received lungs from younger donors (range 9-59, median 39 years).Results: A total of 48 patients (10%) died within 30 days of surgery: 10 (17%) in the older donor group versus 38 (9%) in the younger donor group (P = .08). The operative mortality varied with the underlying lung disease and was higher in recipients presenting with pulmonary hypertension and pulmonary fibrosis than with emphysema or cystic fibrosis. A total of 210 patients died after a median follow-up of 25 months (range 0-136 months). The overall 5- and 10-year survivals were 57% and 38%, respectively. However, the 10-year survival tended to be worse in the older donor group (16% vs 39% in the younger donor group, P = .07). Bronchiolitis obliterans syndrome was the predominant cause of death in recipients of older donors who survived for more than 90 days after surgery (11/17, 65% vs 45/132, 34% in recipients of younger donors surviving for > 90 days after surgery, P = .01).Conclusions: Given the lack of organ donors, lungs from donors aged 60 years or more should be considered for transplantation. However, the use of donors aged 60 years or more is associated with a lower 10-year survival, and bronchiolitis obliterans syndrome plays a significant role as the cause of late death.