P181. Lung Transplantation Can be Safely Performed in Recipients Older than 70 years: A Single Center Analysis of Outcomes
Presented During: Thoracic Poster Session II
University of Toronto
Toronto, ON
Canada - Contact Me
PGY4 general surgery resident at the University of Toronto with a keen interest in thoracic surgery.
Sunday, May 4, 2025: 9:00 AM - 4:00 PM
Seattle Convention Center | Summit
Room: Poster Area, Exhibit Hall
Description
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.
Authors
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)
Institutions
(1) University of Toronto, Toronto, Ontario, (2) Toronto Lung Transplant Program, Toronto, Ontario
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.
Authors
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)
Institutions
(1) University of Toronto, Toronto, Ontario, (2) Toronto Lung Transplant Program, Toronto, Ontario