M. A. Kashem1, J. Levy1, H. Zhao1, Y. Toyoda1 1Temple University,Cardiovascular Surgery,Philadelpha, PA, USA
Introduction: The number of elderly patients requiring a lung transplantation (LTx) continues to grow. However, potential recipient age discrimination continues to be of medical concern. We investigated the survival outcome of elderly primary single and double LTx patients analyzing the UNOS database.
Methods: We analyzed the UNOS database, investigating single and double LTx recipients based on three different elderly age groups from 1987 to 2014. Patients receiving single or double LTx were divided into three different age groups based on recipient age – <69 years old, 70-74 years old, and >75 years old. Using variables such as age, gender, ethnicity, BMI, length of stay (LOS), ECMO and inhaled NO usage, blood groups and types of procedures, three groups were compared for any significance (0.05). Survival outcome was compared using a Kaplan-Meier Curve. Using SAS program, data were expressed Mean+/_standard deviation.
Results: We reviewed 27,980 patients who received LTx where 16,015 had double and 11,888 had single LTx. Within the age cohorts, 27,076 patients age were <69, 729 patients 70-74, and 98 patients >75 years old. Demographic data showed 54% male, 86% white, 7% black, 5% Latino, and 2% other, recipient's age (55±15) years, BMI (24±4) kg/m2, median LOS- 15 days, blood groups: O-45%, A-40%, B-11%, AB-4%, ECMO-1% and inhaled NO-0.21% usage. Log-rank test for equality of survival illustrated significance based on age for patients who received single and double LTx. When comparing the single LTx age cohorts, only the 70-74 vs. >75 year-old patients didn’t show significance (p=0.49), <69 vs. 70-74 years old (p=0.0001), <69 vs. >75 years old (p=0.012). Double LTx recipients showed significant differences when compared between 70-74 vs. >75 years (p=0.01).
Conclusion: Survival outcome of single LTx patients did not show any difference compared to older patients above 70 years whereas younger patients below 69 years of age tend to do better with double LTx. The beneficial survival outcome for single LTx patients extends to an older age than double LTx patients.