Mortality and Development of Cancer in Lung Transplant Recipients with Advanced Age

Abstract

<h3>Purpose</h3> The lung transplant recipient population has become older over the last 10 years. The impact of an aging population on post-operative outcomes, post-transplant survival, and frequency of cancer is not well described. <h3>Methods</h3> We conducted a single center retrospective cohort study of transplant patients between January 2010 and March 2019. We collected baseline characteristics, early post-operative outcomes, post-transplant survival, and time to malignancy. We divided our cohort by age < 65 and age ≥ 65. Differences in baseline variables were compared with chi-square analysis. Cancer was sub-divided into solid organ, skin, PTLD and other hematologic malignancies. Competing risk regression was used to compare time to malignancy and multivariable Cox proportional hazards model was used compare post-transplant survival. <h3>Results</h3> 603 patients underwent transplant from 2010- 2019, of whom 470 were less than 65 years of age. Patients ≥ 65 had lower LAS at transplant (47.6 vs 50.9) and decreased post-transplant survival (HR 1.45, 95%CI: 1.06-1.97, p=0.019). One-year survival was similar, 92.4% vs 89.3% for age ≥ 65 and < 65 respectively, while 5-year survival was decreased among patients ≥ 65, 56.0% vs 70.0%. There was no difference in post-transplant length of stay, ICU length of stay, duration of mechanical ventilation, or discharge destination. There may be an increased risk of all cancer in adults ≥ 65, though this was not significant (sHR: 1.42, 95%CI: 0.98 - 2.05). Patients ≥ 65 had increased risk of skin cancer (sHR: 2.02, 95% CI 1.29-3.18, p=0.002), with an incidence of 21.1% after median of 992 days from transplant (IQR 473 - 1509) compared with 12.1% after median of 1171 days (IQR 596 - 2141) in patients < 65. <h3>Conclusion</h3> Lung transplantation is a viable treatment for patients over 65 with similar early post-transplantation outcomes and a modest reduction in five-year survival. There was an increased risk of skin cancer in adults over 65, and may be an increased risk of all cancers in adults over 65.