Advanced donor age does not impact graft survival in a large single centre lung transplant cohort

The scarcity of donor lungs for lung transplant (LTx) drives wait-list mortality for patients with end-stage lung disease. Thus, LTx centres in Australia and Europe have increasingly accepted age-extended criteria donor lungs for LTx- a practice not common in the USA. Nevertheless, long term data on older lung graft outcomes is limited. This retrospective analysis included 1114 LTx performed at The Alfred between 2010-2024 and compared graft survival (ie time to death or re-LTx) outcomes between donors aged < or ≥65yrs. All potential donors ≥65 yrs had mandatory chest CT assessment. Mean age of LTx recipients was 52±16yrs, 56.5% were male and the mean follow-up was 4.8±3.5yrs. Older donors were used in 146/1114 (13%) of all LTx. LTx recipients of older donors were themselves older 58 ± 11yrs vs 52 ± 16 yrs, p<0.001. However, there was no difference in graft survival for older donor lungs (median graft survival <65 yrs 8.3±0.5 vs ≥65yrs 8.5±0.5, p=0.255,or <70 yrs 8.5±0.6vs ≥70yrs 8.5±0.5,p=0.186). Additionally, there was no difference in the cause of death (malignancy vs infection vs CLAD vs other, p=0.438). Re-LTx occurred more often in the younger donor group (5.2%vs1.4%,p=0.043). Contrary to earlier US reports, graft survival is similar for lungs retrieved from donors <65, compared with donors ≥65(or even 70 yrs). Appropriately assessed age-extended lungs should be routinely considered for LTx. <fig><object-id>erj;64/suppl_68/OA988/F1</object-id><object-id>F1</object-id><object-id>F1</object-id><graphic></graphic></fig>