Outcomes for Recipients with Pulmonary Hypertension Transplanted with Older Lung Donors

R. Asija¹, R. Singh², S. A. Brownlee³, D. M. Giao², A. Kreso², S. Rabi², N. B.. Langer⁴, A. A. Osho², E. Michel^5
1Community Memorial Health Systems, VENTURA, California ²Massachusetts General Hospital, Boston, Massachusetts ³Massachussetts General Hospital, Boston, Massachusetts ⁴Massachusetts General Hospital, Wellesley, Massachusetts ⁵Massachusetts General Hospital, Somerville, Massachusetts

Purpose: There has been considerable momentum in the lung transplant field toward the use of extended criteria donors. The impact of this trend on post-transplant outcomes in patients with pulmonary hypertension (PH) has yet to be evaluated. This study analyzes survival outcomes in recipients with PH receiving lungs from older donors.

Methods: Lung transplant recipients with a diagnosis of PH or mean pulmonary artery pressure (mPAP) greater than 20 mmHg were identified from the Organ Procurement & Transplant Database from October 1, 1987 to September 30, 2022. Donors aged 65 years or higher were defined as older donors. Multi-organ transplants, pediatric recipients and re-transplants were excluded. A 1:3 propensity matched analysis comparing lung transplant recipients with PH using older and younger donors was performed based on recipient and donor characteristics. Post-match balance was confirmed with Standardized Mean Difference of < 0.20. Survival at one year was assessed using Kaplan-Meier and Cox regression modeling. Graft survival was assessed using univariable logistic regression.

Results: There were 8,910 lung transplant recipients identified with PH among which 76 patients received lungs from older donors and 8,834 patients received lungs from younger donors. Patients receiving lungs from older donors were older (66 years vs. 62 years, p< 0.001) and more likely to be on extracorporeal membrane oxygenation (ECMO) at time of transplant (3.9% vs. 0.9%, p=0.03). Older donors were more likely to be female (55.3% vs. 35.0%, p< 0.001), more likely to have diabetes (18.9% vs. 5.8%, p< 0.001) and more likely to have died from stroke (77.6% vs. 31.0%, p< 0.001). On propensity matching, 74 recipients from older donors were matched to 222 recipients from younger donors. In the matched cohort, overall mortality among recipients from older and younger donors was comparable (HR = 1.1, 95% CI 0.84-1.54, p=0.42). All-time graft survival was similar among the two groups (p=0.22).

Conclusion: Despite the comorbid nature of PH, there was no significant difference in overall mortality when comparing PH recipients of older donors to recipients of younger donors. These results suggest older donors can be considered for patients with PH and allow providers to expand the donor pool for this patient population.

Identify the source of the funding for this research project: None