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.<br /> 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.<br /> 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 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 fi cantly reduced longterm survival (P P = .02) compared with male recipients. Median Lung Allocation Scores were similar in both groups.<br /> 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 longterm outcome when transplanting organs of increased size and age. Multicenter studies are warranted to further address this question.