Risk factors for mortality in lung transplant recipients aged ≥65 years: A retrospective cohort study of 5,815 patients in the scientific registry of transplant recipients

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BACKGROUND

Lung transplantation is increasingly performed in recipients aged ≥65 years. However, the risk factors for mortality specific to this population have not been well studied. In lung transplant recipients aged ≥65 years, we sought to determine post-transplant survival and clinical factors associated with post-transplant mortality.

METHODS

We investigated 5,815 adult lung transplants recipients aged ≥65 years in the Scientific Registry of Transplant Recipients. Mortality was defined as a composite of recipient death or retransplantation. The Kaplan–Meier method was used to estimate the median time to mortality. Univariable and multivariable Cox proportional hazards regression models were used to examine the association between time to mortality and 23 donor, recipient, or center characteristics.

RESULTS

Median survival in lung transplant recipients aged ≥65 years was 4.41 years (95% CI: 4.21–4.60 years) and significantly worsened by increasing age strata. In the multivariable model, increasing recipient age strata, creatinine level, bilirubin level, hospitalization at the time of transplantation, single lung transplant operation, steroid use at the time of transplantation, donor diabetes, and cytomegalovirus mismatch were independently associated with increased mortality.

CONCLUSIONS

Among the 8 risk factors we identified, 5 factors are readily available, which can be used to optimize post-transplant survival by informing risk during candidate selection of patients aged ≥65 years. Furthermore, bilateral lung transplantation may confer improved survival in comparison with single lung transplantation. Our results support that after careful consideration of risk factors, lung transplantation can provide life-extending benefits in individuals aged ≥65 years.

Section snippets

Methods

We performed a retrospective cohort study investigating lung transplant recipients in the Scientific Registry of Transplant Recipients (SRTR) aged ≥65 years from May 2005 to March 2018. Our analysis cohort included 5,815 adult first-time lung transplant recipients aged ≥65 years (Figure 1). The study was approved by the institutional review board (Pro00101865) at the Duke University Medical Center, Durham, NC.

Recipient and donor characteristics at the time of transplantation were described

Characteristics of analysis cohort

Among the entire study cohort of 5,815 lung transplant recipients aged ≥65 years, the median (Q1, Q3) age was 68 (66, 70) years, and subjects were predominately male (69%), white (89%), and single lung transplant recipients (55%) with native restrictive lung disease (68%) (Table 1). When stratified by age, the majority were in the 65 to 69 age stratum (73%). The most common comorbidities were chronic hypoxemic respiratory failure (91%), obesity defined as body mass index >30 kg/m2 (17%), and

Discussion

We conducted an analysis of survival outcomes and risk factors for mortality in individuals aged ≥65 years undergoing lung transplantation. Median survival in the 5,815 lung transplant recipients aged ≥65 years was 4.41 years. This survival is reduced when compared with a median of 6.5 years among those aged 35 to 49 years.9 In the multivariable model, increasing recipient age strata, creatinine level, bilirubin level, hospitalization at the time of transplantation, single lung transplantation,

Disclosure statement

C.L.M. receives research support from the National Institutes of Health (NIH) (5T32HL007538-35) and the CHEST Foundation. The remaining authors have no conflicts of interest to disclose.

The authors thank the Scientific Registry of Transplant Recipients (SRTR) for the use of the SRTR patient registry data to conduct this study. In addition, the authors thank the patients, care providers, and clinical coordinators at SRTR reporting centers throughout the United States for their contributions to

Author contributions

Concept and design: C.L.M., J.M.W., M.L.N., S.M.P.

Acquisition, analysis, or interpretation of data: C.L.M., J.M.W., M.L.N., S.M.P., C.W.F.

Drafting of the manuscript: C.L.M., J.M.W., M.L.N., S.M.P.

Critical revision of the manuscript for important intellectual content: C.L.M., J.M.W., M.L.N., C.W.F, S.M.P.

Statistical analysis:  J.M.W., M.L.N.

Administrative, technical, or material support: S.M.P.

Supervision: S.M.P.

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