Lung transplantation outcomes in candidates aged ≥ 70 years old: A 10-year single center experience

BACKGROUND: The establishment of an upper age limit for lung transplantation remains controversial. Although the International Society of Heart and Lung Transplantation designates age over 65 as high risk, contemporary evidence demonstrates septuagenarians can achieve acceptable outcomes. This study aims to elucidate the outcomes in this older demographic compared to younger patients. METHODS: This is a single-center, retrospective review of all patients who received lung transplants over a 10-year period. Recipients were divided into two age groups: those under 70 and those 70 or older. The primary outcome was one-year survival, with secondary outcomes including three- and five-year survival, primary graft dysfunction, and acute kidney injury. RESULTS: A total of 380 lung transplants were performed: 307 (81%) in patients < 70 and 73 (19%) in those ≥ 70 years old. The median age at transplant was 63 (59;67) years in the younger cohort and 72 (71;73) years in the older cohort. There were no differences between groups in gender (p = 0.08), BMI (p = 0.29), lung composite allocation subscore (p = 0.18), or lung allocation score (p = 0.08). A higher proportion of patients aged ≥ 70 years received single lung transplants (p = <0.001) and had a diagnosis of restrictive disease (p < 0.001). Postoperatively, there were no differences in length of stay (p = 0.43), primary graft dysfunction (p = 0.14), or acute kidney injury (p = 0.99) between cohorts. No differences were observed in the 1-year (0.96 [95% CI: 0.93 - 0.98] vs 0.94 [95% CI: 0.86 - 0.98]), 3-year (0.88 [95% CI: 0.83 - 0.91] vs 0.89 [95% CI: 0.79 - 0.95]), or 5-year (0.73 [95% CI: 0.66 - 0.78] vs 0.81 [95% CI: 0.67 - 0.90]) survival rates between patients under 70 and those 70 or older (Log rank: p = 0.62). Multivariable Cox regression identified higher creatinine (HR 4.56, 95% CI 1.74-11.95; p = 0.002) and pretransplant ECMO use (HR 3.85, 95% CI 1.27-11.70; p = 0.017) as independent predictors of mortality, while age ≥ 70 was not significantly associated with mortality (HR 0.67, 95% CI 0.36-1.25; p = 0.206). CONCLUSION: Lung transplantation in patients aged ≥70 yields short- and long-term outcomes comparable to younger recipients, supporting expanded eligibility for carefully selected older candidates.