5-year survival after lung transplant similar in matched older, younger recipients

Key takeaways:

• Propensity score-matched older and younger transplant recipients did not significantly differ in terms of survival.
• This outcome between age groups was also found in procedure type subgroups.

Following propensity matching, lung transplant recipients aged 70 years or older had similar 5-year survival to recipients aged younger than 70 years, according to results published in European Journal of Cardio-Thoracic Surgery.

Roh Yanagida

“Patients older than 70 do as well as younger patients after lung transplant,” Roh Yanagida, MD, PhD, FACS, associate professor of surgery at Lewis Katz School of Medicine at Temple University, told Healio.

In a retrospective single-center study, Yanagida and colleagues evaluated 289 lung transplant recipients aged 70 years or older vs. 699 recipients aged younger than 70 years to find out how survival following transplantation at Temple University Health differs between the two age groups.

“The study portraits the patient characteristics and outcome of the lung transplant program at Temple University Health well,” Yanagida told Healio. “Temple is known to transplant about three times more frequently on patients older than 70 than the national average.”

A greater proportion of patients from the total cohort underwent a single vs. double lung transplant (66.9% vs. 33.1%).

At baseline, researchers found that older recipients significantly differed from younger recipients across three demographics: race (white, 88.2% vs. 74%; P < .0001), sex (men, 72% vs. 61.9%; P = .003) and disease etiology (IPF diagnosis, 52.9% vs. 33.2%; P < .0001).
In terms of clinical variables, lung allocation scores significantly differed between the older and younger patient groups (median, 37.8 vs. 39.4; P = .021).

Fewer older vs. younger transplant recipients underwent a double lung transplant (15.2% vs. 40.5%; P < .0001), and the same was true for intraoperative cardiopulmonary bypass (13.1% vs. 19.9%; P = .019).

Both groups had many patients receiving the anterior axillary surgical approach, but the proportion of older patients was significantly higher than the proportion of younger patients (92.4% vs. 84.9%; P < .0001).

Additionally, recipients in the older vs. younger group spent fewer days in the hospital (median, 15 days vs. 17 days; P = .001).

The average length of survival following transplantation was 2.83 years in the total study population, according to researchers.

One year after transplantation, 85.8% of older patients survived and 89.1% of younger patients survived.

Researchers reassessed survival following propensity score matching. In this analysis, there was no significant difference in survival 5 years after transplantation between the older and younger recipients, but there was “a trend in favor of younger patients.”

In the subgroup of double lung transplant recipients, 79.5% of older patients and 86.6% of younger patients survived at the 1-year mark. Similar to above, there was no significant difference in 5-year survival between the older and younger double lung transplant recipients following propensity score matching.

In the subgroup of single lung transplant recipients, 86.9% of older patients and 90.8% of younger patients survived at the 1-year mark. The two age groups did not significantly differ from each other in 5-year survival after propensity score matching.

“Elderly patients received more single lung transplants, which is less invasive than double lung transplant, that might have led to survival comparable to younger patients,” Yanagida told Healio.

“Future studies can compare single vs. double lung transplant in elderly patients,” Yanagida said.