Cardiac Disease Increased Risk of Death and Early Comorbidities Impacting Prognosis of Lung Transplant Recipients with Extreme Ages

Abstract

<h3>Purpose</h3> Current organ allocation rules prioritized aged patients on the lung transplantation waiting list. Optimizing decision-making algorithms to evaluate candidates, transplant and minimize morbidity, has become the goal of lung transplant programs worldwide. <h3>Methods</h3> This was a retrospective cohort study recruiting patients who underwent lung transplantation, between January 2016 and October 2020, at Wuxi Lung Transplant Center. <b>The transplanted organs were obtained from volunteer donations, and the next of kin voluntarily provided written informed consent. No lungs were obtained from executed prisoners.</b> <h3>Results</h3> Among the entire study cohort of 166 lung transplant recipients aged ≥65 years, subgroups of aged 65-70 years (111 recipients, Group 65-70) and ≥70 years (55 recipients, Group≥70) were included. Group D restrictive lung disease was the main indication of recipients ≥65 years, followed. We found significantly higher percentage of coronary artery stenosis (mid-to severe) in the Group≥70 (30.9% vs. 14.4%). Further, we found valve structural abnormality in both groups, ranging from 8.1% to 16.4%, including medium to severe valve stenosis or regurgitation. ECMO bridging to LT was performed in 5.4% (Group 65-70) and 7.3% (Group≥70). The average cold ischemic time was 434.6 minutes in Group 65-70 and 395.9 minutes in Group≥70, over 6.5 hours. We did more single left lateral lung transplantation in Group≥70 patients mainly consisted of pulmonary fibrosis. Significantly higher occurrence rate of acute rejection, cardiac arrhythmia, pleural effusion were observed in Group≥70. Subjects with cardiac abnormality had significantly increased risk of mortality compared to those without cardiac abnormality (Figure 1). <h3>Conclusion</h3> Our experience from the largest aged lung transplant recipients cohort in eastern population, supported that lung transplantation can be performed in candidates with advanced chronological age and provided life-extending benefits.