Outcomes of Lung Transplant Candidates Aged ≥70 Years During the Lung Allocation Score Era

Abstract

Background: With the increasing age of lung transplant candidates, we studied waitlist and posttransplantation outcomes of candidates ≥70 years during the Lung Allocation Score era.

Methods: Adult lung transplant candidates from 2005 to 2020 in the United Network for Organ Sharing database were included and stratified on the basis of age at listing into 18 to 59 years old, 60 to 69 years old, and ≥70 years old. Baseline characteristics, waitlist outcomes, and posttransplantation outcomes were assessed.

Results: A total of 37,623 candidates were included (52.3% aged 18-59 years, 40.6% aged 60-69 years, 7.1% aged ≥70 years). Candidates ≥70 years were more likely than younger candidates to receive a transplant (81.9% vs 72.7% [aged 60-69 years] vs 61.6% [aged 18-59 years]) and less likely to die or to deteriorate on the waitlist within 1 year (9.1% vs 10.1% [aged 60-69 years] vs 12.2% [aged 18-59 years]; P < .001). Donors for older recipients were more likely to be extended criteria (75.7% vs 70.1% [aged 60-69 years] vs 65.7% [aged 18-59 years]; P < .001). Recipients ≥70 years were found to have lower rates of acute rejection (6.7% vs 7.4% [aged 60-69 years] vs 9.2% [aged 18-59 years]; P < .001) and prolonged intubation (21.7% vs 27.4% [aged 60-69 years] vs 34.5% [aged 18-59 years]; P < .001). Recipients aged ≥70 years had increased 1-year (adjusted hazard ratio [aHR], 1.19 [95% CI, 1.06-1.33]; P < .001), 3-year (aHR, 1.28 [95% CI, 1.18-1.39]; P < .001), and 5-year mortality (aHR, 1.29 [95% CI, 1.21-1.38]; P < .001) compared with recipients aged 60 to 69 years.

Conclusions: Candidates ≥70 years had favorable waitlist and perioperative outcomes despite increased use of extended criteria donors. Careful selection of candidates and postoperative surveillance may improve posttransplantation survival in this population.

Figure 1:

Waitlist outcomes of lung transplant candidates 2005-2020, by age. (A) Cumulative incidence of waitlist death/delisting within one year. (B) Cumulative incidence of transplant within one year.

Figure 2:

Trends in transplanting lung transplant candidates ≥70 years. (A) Percent of recipients ≥70 years at listing, by transplant year. (B) Number of total lung transplant centers (solid line) and centers performing ≥1 transplant in lung transplant candidates ≥70 years (dashed line).

Figure 3:

5-year unadjusted Kaplan Meier survival curves for lung transplants by age, 2005-2020.

Figure 4:

1-year unadjusted Kaplan Meier survival curves in candidates ≥70 years by transplant era.

Figure 5:

5-year unadjusted Kaplan Meier survival curves in candidates ≥70 years by transplant type (bilateral versus single).