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 January 1, 2006, to March 8, 2023, were retrospectively reviewed. The impact of recipient age on survival was analyzed.

Results: Of the 33,644 lung transplant recipients who were identified, 23,125 (69%), 7270 (21%), 2895 (9%), and 354 (1%) were aged 12 to 64, 65 to 69, 70 to 74, and 75 to 79 years, respectively. Older patients underwent single lung transplantation more often (12-64 years: 19%, 65-69 years: 41%, 70-74 years: 57%, 75-79 years: 75%, P < .001). Median survival was greater in bilateral compared with single lung transplant in all groups except those aged 75 to 79 years (12-64 years: 7.6 vs 5.6, P < .001; 65-69 years: 5.8 vs 4.8, P < .001; 70-74 years: 5.0 vs 3.9, P < .001; 75-79 years: 4.0 vs 3.9 years, P = .919). Previous cardiac surgery was associated with increased risk of death (hazard ratio, 1.27; 95% confidence interval, 1.14-1.41, P < .001) and greater likelihood of receiving a single lung transplant with older age (12-64 years: 45.3%, 65-79 years: 71.0%, P < .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. Previous cardiac surgery is associated with worse long-term survival, necessitating careful patient selection, especially in older patients being offered a single lung transplant.