Lung Transplantation Can be Safely Performed in Recipients Older than 70 years: A Single Center Analysis of Outcomes

P0181 

Abstract Submission 

Andreea Matei (1), Tessa Bray (1), Meghan Aversa (2), Ella Huszti (2), Qixuan Li (2), Marcelo Cypel (2), Laura Donahoe (2), Marc Deperrot (2), Andrew Pierre (2), Jonathan Yeung (2), Thomas Waddell (2), Kazuhiro Yasufuku (2), Shaf Keshavjee (2), Elliot Wakeam (2)

(1) University of Toronto, Toronto, Ontario, (2) Toronto Lung Transplant Program, Toronto, Ontario

Andreea Matei    -  Contact Me
University of Toronto

Tessa Bray    -  Contact Me
University of Toronto

Meghan Aversa    -  Contact Me
Toronto Lung Transplant Program

Ella Huszti    -  Contact Me
Toronto Lung Transplant Program

Qixuan Li    -  Contact Me
Toronto Lung Transplant Program

*Marcelo Cypel    -  Contact Me
Toronto Lung Transplant Program

Laura Donahoe    -  Contact Me
Toronto Lung Transplant Program

Marc Deperrot    -  Contact Me
Toronto Lung Transplant Program

Andrew Pierre    -  Contact Me
Toronto Lung Transplant Program

*Jonathan Yeung    -  Contact Me
Toronto Lung Transplant Program

*Thomas Waddell    -  Contact Me
Toronto Lung Transplant Program

*Kazuhiro Yasufuku    -  Contact Me
Toronto Lung Transplant Program

*Shaf Keshavjee    -  Contact Me
Toronto Lung Transplant Program

Elliot Wakeam    -  Contact Me
Toronto Lung Transplant Program

Andreea Matei    -  Contact Me
University of Toronto

Objective: The proportion of lung transplant (LTx) candidates 65 years or older has nearly doubled in the last decade, and recipients aged >70 have begun to be transplanted in high volume centers. However, outcomes in this age group remain infrequently reported. We sought to examine outcomes in the 70+ age group, with comparison to those aged 60-65 and 65-70 years old.

Methods: We conducted a single-center retrospective review of LTx performed between 2008-2021 at our institution using the Lung Transplant Program Database. We excluded patients <60, multiorgan transplant, redo LTx, and those with concurrent cardiac surgery. Baseline characteristics and post-operative outcomes were compared between groups aged 60-65, 65-70, and >70. The Kaplan–Meier method was used to estimate median time to death and chronic lung allograft dysfunction (CLAD). Univariable and multivariable cox proportional hazards regression models examined the association between time to death or CLAD and 19 donor or recipient characteristics.

Results: 802 patients underwent LTx of which 397 (50%) were 60-65, 286 (35%) were 65-70, and 119 (15%) were >70. Primary indications for LTx were interstitial lung disease and chronic obstructive pulmonary disease in all age groups. Patients aged >70 had similar ICU length of stay and the same number of ICU readmissions. We found no difference between age groups for rates of reintubation, tracheostomy, and hospital re-admission. When looking at type of LTx, bilateral LTx was more common (599; 75%). Single LTx was increasingly common with advancing age in groups 60-65 (73; 18%), 65-70 (80; 28%), and 70+ (50; 42%) (p< <0.001). Median overall survival and time to CLAD are examined in Figure 1. After adjustment, age was not a predictor of death or CLAD. Single LTx had a higher rate of death in Cox models (HR 1.45, p=0.03), but similar mortality at 1 year (p=0.35). Those with Cytomegalovirus (CMV) mismatch had higher rates of CLAD. Primary causes of death in patients >70 were infection (17; 25%), CLAD (12; 18%), and malignancy (9; 13%).

Conclusions: LTx can be performed safely and with comparable outcomes in recipients aged ≥70 years. Further study into recipient risk factors such as frailty and the treatment of infectious complications and malignancy after LTx may improve outcomes in this group. We found equivalent short-term but worse long-term outcomes with single LTx; the role of single LTx in this age group needs further study.

End Stage Lung Disease and Lung Transplantation