Outcomes of Lung Transplant Candidates Aged ≥70 Years During the Lung Allocation Score Era.

BACKGROUND: With the increasing age of lung transplant candidates, we studied waitlist and post-transplant outcomes of candidates ≥70 years during the Lung Allocation Score era.

METHODS: Adult lung transplant candidates from 2005-2020 in the United Network for Organ Sharing database were included and stratified based on age at listing into: 18-59 years old, 60-69 years old, and ≥70 years old. Baseline characteristics, waitlist outcomes, and post-transplant outcomes were assessed.

RESULTS: A total of 37,623 candidates were included (52.3% aged 18-59, 40.6% aged 60-69, 7.1% aged ≥70 years). Candidates ≥70 years were more likely than younger candidates to receive a transplant (81.9% vs. 72.7% [aged 60-69] vs. 61.6% [aged 18-59]) and less likely to die or deteriorate on the waitlist within one year (9.1% vs. 10.1% [aged 60-69] vs. 12.2% [aged 18-59], p<0.001). Donors for older recipients were more likely to be extended criteria (75.7% vs. 70.1% [aged 60-69] vs. 65.7% [aged 18-59], p<0.001). Recipients ≥70 years were found to have lower rates of acute rejection (6.7% vs. 7.4% [aged 60-69] vs. 9.2% [aged 18-59], p<0.001) and prolonged intubation (21.7% vs. 27.4% [aged 60-69] vs. 34.5% [aged 18-59], p<0.001). Recipients aged ≥70 years had increased 1- (aHR [95%CI]: 1.19 [1.06-1.33]; p<0.001), 3- (aHR [95%CI]: 1.28 [1.18-1.39]; p<0.001) and 5-year mortality (aHR [95%CI]: 1.29 [1.21-1.38]; p<0.001) compared to recipients aged 60-69.

CONCLUSIONS: Candidates ≥70 years had favorable waitlist and perioperative outcomes, despite increased use of extended criteria donors. Careful candidate selection and post-operative surveillance may improve post-transplant survival in this population.