Journal of Korean medical science · 2026
Differential Impact of Extended-Criteria Donor Use According to Recipient Status in Lung Transplantation: A Nationwide Cohort Study.
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Yeo Hye Ju, Jang Jin Ho, Choi Eunjeong, Lee Jin Gu, Kim Song Yee, Park Samina, Jeon Kyeongman, Haam Seokjin, Cho Woo Hyun
Аннотация
BACKGROUND: The use of extended-criteria donors (ECDs) in lung transplantation remains high in Korea; however, their impact on survival outcomes is not fully understood.
METHODS: We retrospectively analyzed 1,251 adult lung transplant recipients registered with the Korea Network for Organ Sharing (2010-2023). ECDs were defined as donors aged ≥ 55 years with a smoking history ≥ 20 pack-years or a PaO₂/FiO₂ ratio ≤ 300. Survival outcomes were assessed using Kaplan-Meier analysis and multivariable Cox regression, with subgroup comparisons by urgency (status 0 vs. status 1-4) and age (< 65 vs. ≥ 65 years).
RESULTS: Of the 1,251 recipients, 33.7% received ECD lungs. In the multivariable analysis, recipient age, urgency status 0, and ECD use were independently associated with increased one-year mortality. In subgroup analyses, ECD use was consistently associated with higher mortality in status 1-4 recipients (P < 0.001), whereas in status 0 recipients it showed only a trend toward decreased survival (P = 0.056). Among elderly recipients, ECD use significantly increased mortality in status 1-4 but showed only a trend toward decreased survival in status 0 (P = 0.071). In contrast, among younger recipients, ECD use increased mortality in status 1-4 but had no significant effect in status 0.
CONCLUSION: ECD use was consistently associated with higher one-year mortality in recipients with urgency status 1-4, irrespective of age. In contrast, among status 0 recipients, the effect differed by age. These findings highlight the importance of incorporating both recipient urgency and age into donor lung selection.
METHODS: We retrospectively analyzed 1,251 adult lung transplant recipients registered with the Korea Network for Organ Sharing (2010-2023). ECDs were defined as donors aged ≥ 55 years with a smoking history ≥ 20 pack-years or a PaO₂/FiO₂ ratio ≤ 300. Survival outcomes were assessed using Kaplan-Meier analysis and multivariable Cox regression, with subgroup comparisons by urgency (status 0 vs. status 1-4) and age (< 65 vs. ≥ 65 years).
RESULTS: Of the 1,251 recipients, 33.7% received ECD lungs. In the multivariable analysis, recipient age, urgency status 0, and ECD use were independently associated with increased one-year mortality. In subgroup analyses, ECD use was consistently associated with higher mortality in status 1-4 recipients (P < 0.001), whereas in status 0 recipients it showed only a trend toward decreased survival (P = 0.056). Among elderly recipients, ECD use significantly increased mortality in status 1-4 but showed only a trend toward decreased survival in status 0 (P = 0.071). In contrast, among younger recipients, ECD use increased mortality in status 1-4 but had no significant effect in status 0.
CONCLUSION: ECD use was consistently associated with higher one-year mortality in recipients with urgency status 1-4, irrespective of age. In contrast, among status 0 recipients, the effect differed by age. These findings highlight the importance of incorporating both recipient urgency and age into donor lung selection.