Impact of advanced age in lung transplantation: an analysis of United Network for Organ Sharing data

Abstract

Background: Elderly patients are increasingly referred for lung transplantation (LTx) evaluation. Earlier outcomes studies in this cohort are limited by sample size. The United Network for Organ Sharing (UNOS) database provides an opportunity to examine survival in a large cohort of elderly patients.

Study design: We retrospectively reviewed UNOS data to identify 8,363 adult patients who underwent LTx between 1999 and 2006. Patients were stratified into quartiles of age. The primary end point was short-term mortality (30-day, 90-day, and 1-year). Posttransplant survival was compared using Cox proportional hazards regression.

Results: Mean age was 51+/-12 years (SD) (range 18 to 79 years, median 55 years). Age stratification by quartile (Q) was: Q1, 18 to 45 years (n=2,192); Q2, 46 to 55 years (n=2,160); Q3, 56 to 60 years (n=2,000); Q4, 61 to 79 years (n=2,011). The two most common indications for transplantation, chronic obstructive pulmonary disease (40%) and idiopathic pulmonary fibrosis (22%), varied substantially by age, and younger transplantation patients more often had additional indications (ie, cystic fibrosis). Age greater than 60 years (Q4, reference, Q1) was associated with a 37% increase in the risk of death (hazards ratio [HR], 1.37; 95% CI, 1.16 to 1.62; p < 0.001 after risk adjustment). Thirty-day mortality was not statistically different (HR, 1.22; 95% CI, 0.82 to 1.80; p=0.33) for patients older than age 60. Patients 70 years and older had substantially increased risks of 30-day (HR, 2.9; 95% CI, 1.2 to 7.1; p=0.02), 90-day (HR, 3.0; 95% CI, 1.5 to 5.9; p < 0.001), and 1-year mortality (HR, 2.2; 95% CI, 1.2 to 3.9; p=0.008) when compared with the reference of those less than 70 years.

Conclusions: Lung transplantation may be used with caution in older patients (> 60 years) but should not be used for patients older than age 70.