Study provides insights on lung transplantation in advanced age candidates

Frontiers JournalsApr 8 2024

Data from the International Society for Heart and Lung Transplantation (ISHLT) indicates that the proportion of recipients aged 66 and above has risen to 19% by 2017. In the United States, the percentage of recipients aged 65 and above increased to over 30% by 2019. Despite age over 65 being characterized as a relative contraindication, there has been a steady rise in the age threshold considered for lung transplantation.

Jingyu Chen et al., at Wuxi Lung Transplant Center, Wuxi People's Hospital Affiliated to Nanjing Medical University, China, conducted a retrospective cohort study. The study recruited 166 lung transplant recipients aged 65 and above from January 2016 to October 2020 at the largest lung transplant center in China. Subgroups included recipients aged 65-70 years (111 recipients) and those aged 70 and above (55 recipients). The main indication for lung transplantation in recipients over 65 was Group D restrictive lung disease.

A significantly higher percentage of coronary artery stenosis was observed in the group aged 70 and above (30.9% vs. 14.4% in the 65-70 group, P = 0.014). Kaplan-Meier estimates indicated that recipients with cardiac abnormalities had a significantly increased risk of mortality. After adjusting for potential confounders, cardiac abnormality was independently associated with an increased risk of post-lung transplantation mortality (HR 6.37, P = 0.0060).

The study demonstrated that lung transplantation can be performed in candidates with advanced age and can provide life-extending benefits. Recipients aged 70 and above had more frequent comorbidities, including cardiac disease and hypertension. A higher percentage of pulmonary infections requiring hospitalization was observed in the 70 and above group. The study also found a significantly higher proportion of coronary artery abnormalities in the 70 and above group compared to the 65-70 group.
The study's findings provide several key observations regarding the outcomes of lung transplantation in recipients aged 65 and above. Bilateral transplantation is associated with improved long-term survival, while single lung transplantation offers a survival benefit within the first year post-transplant. The benefits of the transplantation type may be related to indications and comorbidities. The study's experience supports that lung transplantation can be performed in advanced age candidates and provides life-extending benefits, which may help the global transplant community expand recipient access despite an increasing number of older recipients.