Donor Smoking and Older Age Increases Morbidity and Mortality After Lung Transplantation H.H. Schultz a, *, C.H. Møller b , M. Zemtsovski c , J. Ravn b , M. Perch a , T. Martinussen d , J. Carlsen a , and M. Iversen a a Department of Cardiology, Section of lung transplantation, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; b Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; c Department of Cardiothoracic Anesthesia, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; and d Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark ABSTRACT Background. The lack of lung transplant donors has necessitated the use of donors with a smoking history and donors of older age. We have evaluated the effects of donor smoking history and age on recipient morbidity and mortality with baseline values of pulmonary function and survival free of chronic lung allograft dysfunction (CLAD) as morbidity variables. Methods. This is a retrospective analysis of 588 consecutive lung transplant recipients and their corresponding 454 donors. Donors were divided into three groups: group 1 included smokers, group 2 nonsmokers, and group 3 had unknown smoking status; these were further divided into three age groups: group A: 0 to 39 years; group B: 40 to 54 years; and group C: 55 years. Results. One hundred fifty-one donors were former or actual smokers, 175 were nonsmokers, and 128 had unknown smoking histories. Baseline forced expiratory volume in 1 second, forced vital capacity, and diffusion capacity of carbon monoxide were lowest in the groups who received lungs from a smoking donor. CLAD-free survival was identical in all smoking groups, and overall survival was better both for lungs from nonsmoking donors and donors with unknown smoking status compared to lungs from smoking donors. One hundred sixty-nine donors were in age group A, 203 in B, and 82 in C. Baseline forced expiratory volume in 1 second, forced vital capacity, and diffusion capacity of carbon monoxide were lowest in the groups who received lungs from donors older than 55 years. Overall survival as well as CLAD-free survival was significantly lower with donors 55 years. Conclusions. Donor smoking history and older donor age impact lung function, mor- tality, and CLAD-free survival after transplantation. Because of a shortage of organs, extended donor criteria may be considered while taking waiting list mortality into account. O RGAN shortage remains a major challenge in solid organ transplantation, and the use of extended criteria donors has increased [1]. The selection of donors with a smoking history and older donors has been considered in lung transplantation. In the selection of donors with smoking history, the use of do- nors with a smoking history above 20 pack-years is not advised [2]. The correlation between donor smoking history and lung function after transplantation has recently been described when using donors >70 years [3], suggesting that the use of older nonsmoking donors can be acceptable. In contrast, the effects of smoking on lung function over time after lung transplantation are not well described. In a nontransplanted cohort of patients, the smoking- and age-related decline in lung function in healthy individuals has been known in detail for many years [4]. In lung *Address correspondence to Hans Henrik Schultz, MD, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark. E-mail: hans.henrik.lawaetz. schultz.01@regionh.dk ª 2017 Elsevier Inc. All rights reserved. 230 Park Avenue, New York, NY 10169 0041-1345/17 https://doi.org/10.1016/j.transproceed.2017.09.021 Transplantation Proceedings, 49, 2161e2168 (2017) 2161