Age-Dependent Gender Disparities in Post Lung Transplant Survival Among Patients With Idiopathic Pulmonary Fibrosis

Abstract

The influence of age and gender on survival after lung transplant in patients with idiopathic pulmonary fibrosis (IPF) is not well defined. The United Network for Organ Sharing database was queried to identify IPF patients receiving lung transplant between 2005 and 2015. There were 6,677 patients receiving lung transplant between May 2015 and June 2015 who met the inclusion criteria, predominantly males (n= 4,769, 71%). Within 1 year posttransplant, the survival curves of male and female recipients diverged, with male recipients having significantly worse survival (log-rank test p= 0.008). Univariate Cox proportional hazards regressions demonstrated no gender difference in survival below age 65 years (HR= 1.051; 95% CI= 0.945, 1.168; p= 0.362) but a significant increase in mortality hazard associated with male gender among patients age 65 years and older (HR= 1.161; 95% CI= 1.000, 1.347; p= 0.049). Multivariable Cox regression accounting for age modulation of the gender effect further demonstrated the emergence of a male disadvantage in post-transplant survival above age 65 years at transplantation. In patients with IPF receiving lung transplant at greater than 65 years of age, male gender is associated with significantly increased risk for death, so referral for lung transplant in IPF should be considered early in the disease course.