• Mark Shacker, Sreeja Biswas Roy, Ashwini Arjuna, Lara W Schaheen, Rajat Walia, Ross M Bremner, and Michael A Smith.
• Creighton University School of Medicine, Phoenix, Arizona.
• J. Thorac. Cardiovasc. Surg. 2024 Dec 6.

BackgroundLung 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.MethodsUnited Network for Organ Sharing data for all primary lung transplants from 1/1/2006 to 3/8/2023 was retrospectively reviewed. Impact of recipient age on survival was analyzed.ResultsOf the 33,644 lung transplant recipients that were identified, 23,125 (69%), 7,270 (21%), 2,895 (9%), and 354 (1%) were aged 12-64, 65-69, 70-74, and 75-79 years, respectively. Older patients underwent single lung transplantation more often (12-64: 19%, 65-69: 41%, 70-74: 57%, 75-79: 75%, p<0.001). Median survival was higher in bilateral compared to single lung transplant in all groups except 75-79 (12-64: 7.6 vs. 5.6, p < 0.001; 65-69: 5.8 vs. 4.8, p < 0.001; 70-74: 5.0 vs. 3.9, p < 0.001; 75-79: 4.0 vs. 3.9 years, p = 0.919). Prior cardiac surgery was associated with increased hazard of death (HR: 1.27, 95% CI, 1.14-1.41, p<0.001) and higher likelihood of receiving a single lung transplant with older age (12-64 years: 45.3%, 65-79 years: 71.0%, p < 0.001).ConclusionsBilateral 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. Prior cardiac surgery is associated with worse long-term survival, necessitating careful patient selection, especially in older patients being offered a single lung transplant.Copyright © 2024. Published by Elsevier Inc.

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