In:
Journal of Clinical Medicine, MDPI AG, Vol. 12, No. 16 ( 2023-08-18), p. 5372-
Abstract:
Objective: To evaluate trends and outcomes of lung transplants (LTx) in recipients ≥ 70 years. Methods: We performed a retrospective analysis of the UNOS database identifying all patients undergoing LTx (May 2005–December 2022). Baseline characteristics and postoperative outcomes were compared by age ( 〈 70 years, ≥70 years) and center volume. Kaplan–Meier analyses were performed with pairwise comparisons between subgroups. Results: 34,957 patients underwent LTx, of which 3236 (9.3%) were ≥70 years. The rate of LTx in recipients ≥ 70 has increased over time, particularly in low-volume centers (LVCs); consequently, high-volume centers (HVCs) and LVCs perform similar rates of LTx for recipients ≥ 70. Recipients ≥ 70 had higher rates of receiving from donor after circulatory death lungs and of extended donor criteria. Recipients ≥ 70 were more likely to die of cardiovascular diseases or malignancy, while recipients 〈 70 of chronic primary graft failure. Survival time was shorter for recipients ≥ 70 compared to recipients 〈 70 old (hazard ratio (HR): 1.36, 95% confidence interval (CI): 1.28–1.44, p 〈 0.001). HVCs were associated with a survival advantage in recipients 〈 70 (HR: 0.91, 95% CI: 0.88–0.94, p 〈 0.001); however, in recipients ≥ 70, survival was similar between HVCs and LVCs (HR: 1.11, 95% CI: 0.99–1.25, p 〈 0.08). HVCs were more likely to perform a bilateral LTx (BLT) for obstructive lung diseases compared to LVCs, but there was no difference in BLT and single LTx likelihood for restrictive lung diseases. Conclusions: Careful consideration is needed for recipient ≥ 70 selection, donor assessment, and post-transplant care to improve outcomes. Further research should explore strategies that advance perioperative care in centers with low long-term survival for recipients ≥ 70.
Type of Medium:
Online Resource
ISSN:
2077-0383
Language:
English
Publisher:
MDPI AG
Publication Date:
2023
detail.hit.zdb_id:
2662592-1
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