Waiting List Mortality and Potential Risk Factors in Lung Transplant Candidates: A Single-Center Data

Lung transplantation (LTx) is a vital treatment for end-stage lung diseases; however, donor lung availability remains limited. This study aimed to evaluate survival durations, mortality risk factors, and waiting list mortality among patients listed for LTx at a single center.

We conducted a retrospective analysis of patients listed for lung transplantation at Kartal Koşuyolu Specialized Training and Research Hospital between January 2017 and May 2023. Patients were classified into 5 diagnostic groups: Obstructive, Vascular, Suppurative, Major Idiopathic Interstitial Pneumonia (IIP), and Others. Survival analyses were performed using Kaplan-Meier curves and log-rank tests, while Cox regression identified independent mortality risk factors.

Among 202 patients listed, 66.8% (n = 135) were male, with a mean age of 42.9 ± 15.3 years. Overall, 34.7% (n = 70) died while on the waiting list. The Major IIP group exhibited the highest mortality rate (47.7%). Significant predictors of mortality included shorter height, diagnosis of Major IIP or vascular disease, elevated systolic pulmonary artery pressure (PAPs), reduced echocardiographic TAPSE/PAPs ratio, and increased pulmonary vascular resistance (PVR). A PAPs ≥52 mmHg was associated with a 3.99-fold increased risk of mortality. Patients in the vascular group had the shortest survival time (15.6 ± 5.0 months).

Donor organ scarcity prolongs lung transplantation waiting times, contributing to considerable mortality. Recognition of key mortality risk factors, especially in Major IIP and vascular disease patients is essential for optimizing listing strategies and clinical management to improve outcomes.