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. 2023 Jun 30;15(6):2997-3012.
doi: 10.21037/jtd-22-1414. Epub 2023 May 24.

Twenty-year survival following lung transplantation

John James Miggins  1 , Ross M Reul Jr  2 , Spencer Barrett  3 , Abbas Rana  4 , Ahmed Alnajar  5 , Jordan Dunson  6 , Alexis Shafii  7 , Puneet Garcha  8 , John Goss  4 , Gabriel Loor  7
Affiliations

Twenty-year survival following lung transplantation

John James Miggins et al. J Thorac Dis. .

Abstract

Background: Lung transplantation median survival has seen improvements due to recognition of short-term survival factors but continues to trail behind other solid organs due to limited understanding of long-term survivorship. Given the creation of the United Network for Organ Sharing (UNOS) database in 1986, it was difficult to accrue data on long-term survivors until recently. This study characterizes factors impacting lung transplant survival beyond 20 years, conditional to 1-year survival.

Methods: Lung transplant recipients listed in UNOS from 1987 to 2002 who survived to 1 post-transplant year were reviewed. Kaplan-Meier and adjusted Cox regression analyses were performed at 20 and 10 years to identify risk factors associated with long-term outcomes independent of their short-term effects.

Results: A total of 6,172 recipients were analyzed, including 472 (7.6%) recipients who lived 20+ years. Factors associated with increased likelihood of 20-year survival were female-to-female gender match, recipient age 25-44, waitlist time >1 year, human leukocyte antigen (HLA) mismatch level 3, and donor cause of death: head trauma. Factors associated with decreased 20-year survival included recipient age ≥55, chronic obstructive pulmonary disease/emphysema (COPD/E) diagnosis, donor smoking history >20 pack-years, unilateral transplant, blood groups O&AB, recipient glomerular filtration rate (GFR) <10 mL/min, and donor GFR 20-29 mL/min.

Conclusions: This is the first study identifying factors associated with multiple-decade survival following lung transplant in the United States. Despite its challenges, long-term survival is possible and more likely in younger females in good waitlist condition without COPD/E who receive a bilateral allograft from a non-smoking, gender-matched donor of minimal HLA mismatch. Further analysis of the molecular and immunologic implications of these conditions are warranted.

Keywords: Long-term survival; bilateral transplant; bronchiolitis obliterans; gender matching.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-22-1414/coif). GL serves as a consultant and scientific board advisor for TransMedics and Abiomed Breethe, and he receives research grant support from TransMedics, Abiomed Breethe, AtriCure, and the JLH Foundation. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Kaplan-Meier survival function for 1-year survivors by gender-matched cohort. Log-Rank test P=0.0001.
Figure 2
Figure 2
Kaplan-Meier survival function for 1-year survivors by recipient age. Log-Rank test P<0.0001.
Figure 3
Figure 3
Kaplan-Meier survival function for 1-year survivors by single versus bilateral transplant. Log-Rank test P<0.0001.
Figure 4
Figure 4
Kaplan-Meier survival function for 1-year survivors by recipient diagnosis. Log-Rank test P<0.0001. COPD, chronic obstructive pulmonary disease; IPF, idiopathic pulmonary fibrosis; UIP, usual interstitial pneumonitis.
See this image and copyright information in PMC

Comment in

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