Analysis of the waitlist performance and post-transplant outcomes of lung transplant in elderly recipients in Korea: A nationwide cohort study

Background

There is a lack of information on the waitlist performance and post-transplant outcomes of lung transplants in elderly recipients in Korea.

Methods

We retrospectively reviewed and analyzed data from the Korean Network for Organ Sharing database between March 2010 and August 2023.

Results

In total, 2574 patients were listed for lung transplantation during the study period, with 511 (19.9%) of them being over 65 years of age. Among these, 188 patients (36.8%) underwent transplantation, while 184 patients (36%) passed away without undergoing transplantation at the time of data extraction. The most prevalent underlying disease on the waitlist was idiopathic pulmonary fibrosis, accounting for 68.1%. The 1-year survival rate was significantly lower in the elderly compared to that in the nonelderly (65.4 vs. 75.4%; p = .004). In the multivariate Cox analysis, elderly (hazard ratio [HR], 1.49; 95% CI, 1.14–1.97; p = .004) and a high urgent status at registration (HR, 1.83; 95% CI, 1.40–2.40; p < .001) were significantly associated with post-transplant 1-year mortality. Kaplan–Meier curves demonstrated a significant difference in post-transplant mortality based on the urgency status at enrollment (χ² = 8.302, p = .016). Even with the same highly urgent condition at the time of transplantation, different prognoses were observed depending on the condition at listing (χ² = 9.056, p = .029).

Conclusion

The elderly exhibited worse transplant outcomes than nonelderly adults, with a highly urgent status at registration identified as a significant risk factor. Unprepared, highly urgent transplantation was associated with poor outcomes.