Differential Outcomes of Lung Transplant Recipients as They Age: Is over 70 Too Old? No!

Abstract

PurposeLung transplantation (LTX) is generally reserved for the young due to perioperative complications & organ utilization. We sought to evaluate the long-term outcomes of LTX in the septuagenarian.MethodsRetrospectively, LTX recipients in the UNOS transplant registry (May 1, 2005 to June 12, 2020) were stratified into 18-59, 60-69, and >=70 years of age. Recipient and transplant characteristics were evaluated for survival, cause of death (COD), length of stay (LOS) and complications. A Kaplan-Meier analysis examined long-term survival for all patients stratified by age, specifically looking at COD.ResultsA total of 27,632 recipients met inclusion criteria. As recipients aged, we found a decrease in proportion of cystic fibrosis & an increase in restrictive disease while obstructive disease peaked in the 60-69yo cohort (p<0.001). Recipient to donor age difference significantly increased with older recipients (p<0.001). >=70yo had higher rates of single LTX, male gender and white race (p<0.001). Older recipients had significantly longer recovery distances traveled with paradoxical shorter ischemic times, shorter LOS and were transplanted at higher volume centers. There was no difference with in-hospital mortality (p=0.5). Rejection during initial hospitalization and within 1 year and post-transplant dialysis incidence decreased with age. Graft and pulmonary failure were common COD in younger patients while malignancy and cardio/cerebrovascular diseases were common COD in >= 70yo (Figure).ConclusionSeptuagenarian LTX candidates may be safely transplanted with relatively few complications. Young transplant recipients appear more vulnerable to rejection and die more often of graft failure complications. Malignancy and cardio/cerebrovascular etiologies were more common COD in older recipients. Immuno-senescence and conditions of the aged are likely contributing factors to the less rejection and graft failure observations. The >=70yo should be considered a good LTX candidate. Lung transplantation (LTX) is generally reserved for the young due to perioperative complications & organ utilization. We sought to evaluate the long-term outcomes of LTX in the septuagenarian. Retrospectively, LTX recipients in the UNOS transplant registry (May 1, 2005 to June 12, 2020) were stratified into 18-59, 60-69, and >=70 years of age. Recipient and transplant characteristics were evaluated for survival, cause of death (COD), length of stay (LOS) and complications. A Kaplan-Meier analysis examined long-term survival for all patients stratified by age, specifically looking at COD. A total of 27,632 recipients met inclusion criteria. As recipients aged, we found a decrease in proportion of cystic fibrosis & an increase in restrictive disease while obstructive disease peaked in the 60-69yo cohort (p<0.001). Recipient to donor age difference significantly increased with older recipients (p<0.001). >=70yo had higher rates of single LTX, male gender and white race (p<0.001). Older recipients had significantly longer recovery distances traveled with paradoxical shorter ischemic times, shorter LOS and were transplanted at higher volume centers. There was no difference with in-hospital mortality (p=0.5). Rejection during initial hospitalization and within 1 year and post-transplant dialysis incidence decreased with age. Graft and pulmonary failure were common COD in younger patients while malignancy and cardio/cerebrovascular diseases were common COD in >= 70yo (Figure). Septuagenarian LTX candidates may be safely transplanted with relatively few complications. Young transplant recipients appear more vulnerable to rejection and die more often of graft failure complications. Malignancy and cardio/cerebrovascular etiologies were more common COD in older recipients. Immuno-senescence and conditions of the aged are likely contributing factors to the less rejection and graft failure observations. The >=70yo should be considered a good LTX candidate.