Lung transplantation in older patients with cystic fibrosis: analysis of UNOS data

The lifespan for patients with cystic fibrosis (CF) is increasing. As a result, greater numbers of older CF patients are presenting for lung transplantation (LTx). The UNOS database provides an opportunity to examine outcomes for this population.

We retrospectively reviewed UNOS data to identify 1,637 first-time LTx recipients with the indication of CF between 1999 and 2007. Patients were stratified by quartile age. Our primary end-point was all-cause mortality. Post-transplant survival was compared using Cox proportional hazards regression.

Of the patients who met the inclusion criteria, the distribution by age quartile was as follows: Quartile 1 (Q1), age 7 to 20 years, N = 408; Q2, 21 to 27, N = 470; Q3, 28 to 34, N = 365; and Q4, >or=35, N = 394. Patients in the lowest quartile had the lowest 5-year cumulative survival (43%); 19% lower than for patients in Quartile 4 (age >or=35, cumulative survival = 62%; p < 0.001). On multivariable analysis, patients in Q3 and Q4 had a 38% and 32% reduction in cumulative hazard for death, respectively (reference Q1, age 7 to 20) (hazards ratios: Q3, 0.62 [0.46 to 0.85], p < 0.001; Q4, 0.68 [0.5 to 0.93], p = 0.02). Thirty-day and 1-year cumulative survival were not different among the four quartiles (30-day survival: Q1, 96.4%; Q2, 96.2%; Q3, 96.2%; and Q4, 95.5% [p = 0.94]; 1-year survival: Q1, 83.7%; Q2, 83.1%; Q3, 85.4%; and Q4, 83.4% [p 0.88]). Increasing age was associated with decreases in early post-operative infections, reduction in the cumulative hazard of developing bronchiolitis obliterans (BO) syndrome, and decreases in hospitalizations and treatment for rejection.

The UNOS database has provided a large series examining survival after LTx in older CF patients. LTx is safe in this group and older age may be protective against infection, rejection and BO syndrome.