Lung Transplantation Outcomes in Recipients Aged 70 Years or Older and the Impact of Center Volume

Abstract

Objective: To evaluate trends and outcomes of lung transplants (LTx) in recipients ≥ 70 years. Methods: We performed a retrospective analysis of the UNOS database identifying all patients undergoing LTx (May 2005–December 2022). Baseline characteristics and postoperative outcomes were compared by age (<70 years, ≥70 years) and center volume. Kaplan–Meier analyses were performed with pairwise comparisons between subgroups. Results: 34,957 patients underwent LTx, of which 3236 (9.3%) were ≥70 years. The rate of LTx in recipients ≥ 70 has increased over time, particularly in low-volume centers (LVCs); consequently, high-volume centers (HVCs) and LVCs perform similar rates of LTx for recipients ≥ 70. Recipients ≥ 70 had higher rates of receiving from donor after circulatory death lungs and of extended donor criteria. Recipients ≥ 70 were more likely to die of cardiovascular diseases or malignancy, while recipients < 70 of chronic primary graft failure. Survival time was shorter for recipients ≥ 70 compared to recipients < 70 old (hazard ratio (HR): 1.36, 95% confidence interval (CI): 1.28–1.44, p < 0.001). HVCs were associated with a survival advantage in recipients < 70 (HR: 0.91, 95% CI: 0.88–0.94, p < 0.001); however, in recipients ≥ 70, survival was similar between HVCs and LVCs (HR: 1.11, 95% CI: 0.99–1.25, p < 0.08). HVCs were more likely to perform a bilateral LTx (BLT) for obstructive lung diseases compared to LVCs, but there was no difference in BLT and single LTx likelihood for restrictive lung diseases. Conclusions: Careful consideration is needed for recipient ≥ 70 selection, donor assessment, and post-transplant care to improve outcomes. Further research should explore strategies that advance perioperative care in centers with low long-term survival for recipients ≥ 70.

ERS International Congress 2023: highlights from the Thoracic Surgery and Lung Transplantation Assembly

“…Data from the Organ Procurement and Transplantation Network Registry 2021 demonstrated unfavourable survival outcomes in recipients aged >65 years [ 45 ]. The retrospective analysis by I yanna et al [ 46 ] demonstrated that the rate of LuTx in recipients aged ≥70 years increased particularly in low-volume centres (LVCs), and currently high-volume centres (HVCs) and LVCs perform similar rates of LuTx for recipients aged ≥70 years. Survival time was shorter for recipients aged ≥70 years compared to recipients aged <70 years (HR 1.36, 95% CI 1.28–1.44; p<0.001).…”

“…Survival time was shorter for recipients aged ≥70 years compared to recipients aged <70 years (HR 1.36, 95% CI 1.28–1.44; p<0.001). HVCs were associated with a survival advantage in recipients aged <70 years (HR 0.91, 95% CI 0.88–0.94; p<0.001); but for recipients aged ≥70 years survival did not differ significantly between HVCs and LVCs (HR 1.11, 95% CI 0.99–1.25; p<0.08) [ 46 ]. A.M. Holm summarised that among many valid criteria for rationing life years, such as sarcopenia, urgency, frailty or telomere lengths, the age is the only one absolutely certain and absolutely fair.…”