SCI 22 February 2023

LUNG TRANSPLANT OUTCOME FROM SELECTED OLDER DONORS (≥ 70 YEARS) EQUALS YOUNGER DONORS (< 70 YEARS): A PROPENSITY- MATCHED ANALYSIS

（Annals of Surgery；IF: 13.787）

Cedric Vanluyten; Christelle M. Vandervelde; Robin Vos; Jan Van Slambrouck; Steffen Fieuws; Paul De Leyn; Philippe Nafteux; Herbert Decaluwé; Hans Van Veer; Lieven Depypere; Yanina Jansen; An-Lies Provoost; Arne P. Neyrinck; Catherine Ingels; Bart M. Vanaudenaerde; Laurent Godinas; Lieven J. Dupont; Geert M. Verleden; Dirk Van Raemdonck; Laurens J. Ceulemans

CORRESPONDENCE TO: laurens.ceulemans@uzleuven.be 

Objective 目的 

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.

描述我们对≥70岁供体进行肺移植（LTx）的经验，并与70岁以下供体进行倾向匹配队列研究比较短期和长期结果。

Summary background data 研究背景 

While extended-criteria donors have been widely used to enlarge the donor pool, the experience with LTx from older donors (≥70 years) remains limited.

虽然扩大标准捐助者已被广泛用于扩大捐助者库，但≥70岁的老年捐助者肺移植经验仍然有限。

Methods 方法 

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.

回顾性分析了2010年至2020年间所有单中心的双侧肺移植。对供体（类型、性别、吸烟史、X射线异常、PaO2/FiO2比值、呼吸机使用时间）和受体特征（年龄、性别、LTx适应症、围手术期体外生命支持、CMV不匹配）进行1:1匹配。分析3级原发性移植物失功（PGD）、5年患者和无慢性肺移植功能障碍（CLAD）生存率。

RESULTS 结果 

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 years) versus 49 years (range 12-69 years) 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% versus 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. 

647例双侧LTx中，69例来自≥70岁的供体。老年供体队列的平均年龄为74岁（70-84岁），而匹配的年轻组为49岁（12-69岁）。通气支持时间、ICU或住院时间无显著差异。老年组PGD-3为26%，而年轻供体受者为29%（p=0.85）。再干预率相当（29%对16%；p=0.10）。随访支气管镜检查显示支气管吻合并发症无差异（p=1.00）。五年患者和无CLAD生存率分别为73.6%对73.1%（p=0.72）和51.5%对59.2%（p=0.41）。

Conclusions 结论 

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 years). 

来自≥70岁的特定供体的LTx是可行和安全的，在与年轻供体（<70岁）的倾向匹配分析中，可产生相当的短期和长期结果。

来源 | 健康界

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