Evaluating mortality risk in elderly lung transplant patients

Lung transplantation has greatly improved survival rates due to advances in surgery and care; however, data on mortality risks in elderly recipients remain limited. This study aimed to assess these risks.

We conducted a cohort study using data from a single-institution lung transplant registry spanning January 2018 to December 2023. A comprehensive analysis was performed on the baseline characteristics and post-transplant complications, including infections and rejection.

A total of 337 lung transplantations were performed during the study period. Of these, elderly recipients (n=54) accounted for 16.0% and were less likely to undergo bilateral lung transplantation (25.9% vs. 70.3%, P<0.001) than younger recipients. They also showed lower Lung Allocation Score (46.4±11.4 vs. 57.2±19.9, P=0.002). Survival rates at 1 year did not differ significantly between older and younger cohorts (82.7% vs. 90.1%, P=0.30). On univariate analysis, serum creatinine level was the only significant and independent predictor of post-transplant survival [odds ratio (OR): 10.9, 95% confidence interval (CI): 1.44-82.0, P=0.02]. The best threshold for serum creatinine was identified as 0.85 mg/dL using the Youden index (sensitivity 73.3%, specificity 53.8%, index 0.27).

These findings are indicative of advancements in lung transplantation and suggest that the current age-based eligibility standards merit re-evaluation.