Orthotopic Lung Transplantation in Patients over Seventy Years of Age

Abstract

<h3>Purpose</h3> Comorbidity profile, disease etiology, and donor lung quality all affect outcomes after lung transplantation. However, the effect of age on survival after lung transplantation in carefully selected patients is less certain. The study evaluated short-term outcomes in elderly patients referred for lung transplantation stratified by those who received lung transplant. <h3>Methods</h3> This study was a retrospective review of all patients undergoing evaluation for lung transplantation at single institution from December 2015 to July 2020 by four operating surgeons. Patients seventy years of age and older who were transplanted (n=32) or evaluated for transplant but denied (n=108) were included for analysis. In-hospital events including reintubation, tracheostomy, stroke, dialysis, primary graft dysfunction (PGD), extracorporeal membrane oxygenation (ECMO), or re-operation were captured. Short-term follow-up with linkage to state-wide vital statistics death data was used to analyze survival outcomes with a mean follow-up of 2.8 (range 0.3-5.7) years. <h3>Results</h3> In the referred only group, mean age was 73.2 (standard deviation (SD) 2.5) years versus 73 (SD 2.1) in the transplanted group, p>0.05. Disease etiology was different between groups (p=0.02), but the most frequent etiology was idiopathic pulmonary fibrosis in both, 66.6% (n=72) versus 53.1% (n=17). There was a higher proportion of oxygen required at rest in the transplant patients (96.9% (n=31) versus 67.3% (n=72)), p=0.0008. The most frequent in-hospital event seen in transplanted patients was PGD in 9.4% (n=3). Three-year survival was 69.1% (95% confidence interval (CI), 46-83.9) in the transplanted patients versus 58% (95% CI, 46.8-67.7) in the referred group, p=0.25 (Figure). <h3>Conclusion</h3> In carefully selected patients over the age of seventy at experienced centers, lung transplant offers comparable short-term survival rates. Age alone should not preclude patients from lung transplant, as the short-term survival rates are comparable to optimal medical therapy.