Survival Benefit of Lung Transplant in Septuagenarians: A United Network of Organ Sharing Database Analysis

Abstract

<h3>Purpose</h3> The benefit of lung transplant in septuagenarians is questioned on the grounds that recipients must be so highly selected that their baseline survival negates any benefit of transplant. This study evaluated the short-term outcomes and survival benefit of lung transplant in septuagenarians compared to waitlist patients that did not receive a transplant. <h3>Methods</h3> Using the United Network for Organ Sharing database, lung transplant recipients and waitlist candidates from 1991-2021 were analyzed. Dual organ transplant candidates/recipients and those without validated records were excluded. The cohort consisted of 3109 patients, 12.9% (400) were waitlist candidates and 87.1% (2709) were lung transplant recipients all seventy years of age and older. Propensity matching on eleven demographic characteristics, year of waitlist/surgery, and waitlist time produced 384 pairs with correction of baseline differences. Short-term survival was compared with a Cox regression model. Median follow-up of the lung transplants was 2 years (interquartile range (IQR) 0.8-4) versus 0.3 (IQR 0.1-0.6) for waitlist candidates. <h3>Results</h3> Lung transplants in septuagenarians increased from 0.14% (1) in 1991 to 12.2% (193) transplants in 2021, p<0.001. The median age of the unmatched waitlist candidates and recipients was 71 (IQR 70-73), with a listing lung allocation score of 38.7 (IQR 34-48.5) and 37.8 (IQR 34.1-44.8), respectively, all p>0.5. In the unmatched cohort, there was a higher proportion of females in the waitlist group (37.3% (149) vs 25% (677)), p<0.0001. In matched patients, six-month survival was lower in the waitlist group 42% (95% CI 36.4-47.4) versus 91.1% (95% CI 87.6-93.7), p<0.0001 (Figure). <h3>Conclusion</h3> Lung transplant can be offered in septuagenarians with survival benefit in those eligible for lung transplant. These findings may inform the transplant community that selection bias due to age should be reconsidered.