Lung Transplantation Outcomes in Candidates Aged ≥ 70 Years Old: A 10-Year Single Center Experience

Document Type

Conference Proceeding

Publication Date

2025

Publication Title

Journal of Heart and Lung Transplantation

Abstract

Purpose: Lung transplantation offers significant benefits for patients with end-stage lung disease, but the establishment of an upper age limit remains controversial. While the International Society of Heart and Lung Transplantation identifies age over 65 as a high-risk factor for poor outcomes, growing evidence shows that patients aged ≥ 70 can achieve outcomes comparable to younger cohorts. This study aims to elucidate the outcomes of lung transplantation in this older demographic compared to younger patients.

Methods: This is a single-center, retrospective review of a prospectively curated lung transplant database. Patients who received single or bilateral lung transplants between 2013 and 2024 were included. Recipients were divided into two age groups: those < 70 and those ≥ 70. The primary outcome was one-year survival, with secondary outcomes including three- and five-year survival, primary graft dysfunction, and acute kidney injury.

Results: A total of 382 lung transplants were performed, with 305 in patients < 70 years old and 77 in those ≥ 70 years old. The median (interquartile range) age at transplant was 63 (59;67) years in the younger cohort and 72 (71;73) years in the older cohort. There were no differences between groups in gender (male: 59% vs. 70%, p = 0.08), ethnicity (p = 0.53), BMI (26.4 vs. 25.3 kg/m², p = 0.29), lung composite allocation score (23.4 vs. 25.0, p = 0.18), or lung allocation score (39.2 vs. 40.7, p = 0.078). A higher proportion of patients aged ≥ 70 received single lung transplants compared to those aged < 70 (38% vs. 20%, p = 0.0037). Intraoperatively, there were no difference in the rates of cardiopulmonary bypass (11% vs. 7%, p = 0.32) or VA ECMO (42% vs. 43%, p = 0.95). Postoperatively, there were no differences in length of stay (18 vs. 17.5 days, p = 0.43), ICU stay (4.3 vs. 3.9 days, p = 0.22), grade 3 primary graft dysfunction at 72 hours (10% vs. 4%, p = 0.14), or acute kidney injury (40% in both groups). No differences were observed in the one-, three-, and five-year survival rates between patients under 70 and those 70 or older (p = 0.48); the rates were 96% vs. 94%, 88% vs. 89%, and 73% vs. 81%, respectively.

Conclusion: Lung transplantation in patients ≥ 70 yields short- and long-term outcomes comparable to younger recipients. These findings support considering an expansion of eligibility for carefully selected candidates aged 70 and older.

Volume

44

Issue

4 Suppl

First Page

S197

Comments

45th Annual Meeting & Scientific Sessions of the International Society for Heart and Lung Transplantation (ISHLT) Apr 27-30, 2025, Boston, MA

Richard DeVos Lung Transplant Program

Last Page

S197

DOI

10.1016/j.healun.2025.02.396

ISSN

1053-2498

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