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Objectives: To study the impact of using the US Public Health Service broadened definition of "increased-risk" donors (2013) in comparison with "high-risk" (1994) and standard infectious risk donors on lung transplant recipient outcomes., Methods: Patients who underwent lung transplant between January 1, 2006, and May 31, 2017, in the Scientific Registry of Transplant Recipients were divided into 2 cohorts, recipients of: (1) high-risk donors: January 1, 2006, to October 1, 2013, and (2) increased-risk donors: January 1, 2014, to May 31, 2017, and compared with matched recipients who received standard-risk donors. Risks for acute rejection, patient, and graft survival using propensity score matched cohorts, multivariable logistic, and Cox models were examined., Results: In total, 18,490 lung transplant recipients were analyzed with 36% transplanted during the increased-risk donor definition period. The proportion of donors classified as nonstandard infectious risk increased with the definition change (8% high-risk donors vs 22% increased-risk donors; P < .001). In both cohorts, male patients with a lower forced expiratory volume in 1 second and greater creatinine were more likely to receive an organ from increased risk donors. Neither graft nor patient survival differed by donor type in either period. Acute treated rejection within 1 year did not differ by period for recipients of increased risk donors (odds ratio, 0.87; P = .23) or recipients of high-risk donors (odds ratio, 1.2; P = .27)., Conclusions: The 2013 broadened definition of donor risk increased the proportion of nonstandard infectious risk donors. Recipients of increased/high-risk donors had similar graft and patient survival compared with standard-risk donors., (Copyright © 2019 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)

Background: Age has been implicated as a factor in the plateau of long-term survival after lung transplant., Methods: We used data from the Scientific Registry of Transplant Recipients to identify all recipients of lung transplant aged ≥18 years of age between January 1, 2006, and February 19, 2015. A total of 14,253 patients were included in the analysis. Survival was estimated using a nonproportional hazard model and random-survival forest methodology was used to examine risk factors for death. Final selection of model variables was performed using bootstrap aggregation. Age was analyzed as both a continuous and categorical variable (age <30, 30-55, and >55 years). Risk factors for death were obtained for the entire cohort and additional age-specific risk factors were identified for each age category., Results: The median age at transplant was 59 years. There were 1,098 (7.7%) recipients <30 years, 4,201 (29.5%) 30 to 55 years, and 8,954 (62.8%) >55 years of age. Age was the most significant risk factor for death at all time-points following transplant and its impact becomes more prominent as time from transplant increases. Risk factors for death for all patients included extremes of age, higher creatinine, single lung transplant, hospitalization before transplant, and increased bilirubin. Risk factors for death differed by age with social determinants of health disproportionately affecting survival for those in the youngest age category., Conclusions: The youngest and oldest adult recipients experienced the lowest posttransplant survival through divergent pathways that may present opportunities for intervention to improve survival after lung transplant., (Copyright © 2019 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)

This article provides a summary of the changes in lung transplantation after implementation of the Lung Allocation Score in 2005. Specific issues that are addressed include impact of diagnosis group, age, critical illness, and geographic disparities in transplant.