Lung Transplant Outcomes in Recipients of Advanced Age: Are Two Always Better Than One?

Background: Lung transplantation has become more common in patients aged 65 years and older. We aimed to examine outcomes across age groups and identify risk factors for decreased survival.

Methods: United Network for Organ Sharing data for all primary lung transplants from 1/1/2006 to 3/8/2023 was retrospectively reviewed. Impact of recipient age on survival was analyzed.

Results: Of the 33,644 lung transplant recipients that were identified, 23,125 (69%), 7,270 (21%), 2,895 (9%), and 354 (1%) were aged 12-64, 65-69, 70-74, and 75-79 years, respectively. Older patients underwent single lung transplantation more often (12-64: 19%, 65-69: 41%, 70-74: 57%, 75-79: 75%, p<0.001). Median survival was higher in bilateral compared to single lung transplant in all groups except 75-79 (12-64: 7.6 vs. 5.6, p < 0.001; 65-69: 5.8 vs. 4.8, p < 0.001; 70-74: 5.0 vs. 3.9, p < 0.001; 75-79: 4.0 vs. 3.9 years, p = 0.919). Prior cardiac surgery was associated with increased hazard of death (HR: 1.27, 95% CI, 1.14-1.41, p<0.001) and higher likelihood of receiving a single lung transplant with older age (12-64 years: 45.3%, 65-79 years: 71.0%, p < 0.001).

Conclusions: Bilateral lung transplantation offers a survival advantage over single lung transplantation in recipients up to 74 years of age. Recipients aged 75 to 79 have poor long-term survival. Prior cardiac surgery is associated with worse long-term survival, necessitating careful patient selection, especially in older patients being offered a single lung transplant.