Increased Donor Organ Size and Age is Associated with Reduced Survival in Female Lung Transplant Recipients

Background: Organ selection in lung transplantation (LTx) is still controversial. We here analyze the impact of mismatches in size, age, and gender on early and long-term outcome after LTx.

Methods: Retrospective analysis of donor and recipient characteristics of patients who underwent double LTx between March 2003 and December 2021. Statistical analysis was performed using SPSS and GraphPad software.

Results: Two hundred three patients were included (94 women and 109 men). In the whole cohort, oversizing donor organs 10% to 20% compared to the recipients' predicted total lung capacity led to a decreased incidence of severe Primary Graft Dysfunction grades 2 and 3 (2/3; 15% vs 41%, P = .03), and further oversizing > 20% was associated with reduced long-term survival (hazard ratio, 2.33, P = .011). Analyzing donor and recipient age, we found that increased donor age correlated with reduced long-term survival (P = .013). In this cohort, female recipients received older organs (median 57 vs 46 years, P = .0003) and had a higher incidence of > 20% oversizing (13% vs 4%, P = .019) of donor lungs, which resulted in a significantly reduced long-term survival (P = .02) compared with male recipients. Median Lung Allocation Scores were similar in both groups.

Conclusion: Mismatch of donor age and size can be important for organ function and survival in LTx recipients. Particularly female recipients seem to have a higher risk for unfavorable long-term outcome when transplanting organs of increased size and age. Multicenter studies are warranted to further address this question.

Trial registration number: (DKRS): 00033312.