Language
English
Publication Date
6-30-2023
Journal
Journal of Thoracic Disease
DOI
10.21037/jtd-22-1414
PMID
37426158
PMCID
PMC10323557
PubMedCentral® Posted Date
5-24-2023
PubMedCentral® Full Text Version
Post-print
Abstract
BACKGROUND: Lung transplantation median survival has seen improvements due to recognition of short-term survival factors but continues to trail behind other solid organs due to limited understanding of long-term survivorship. Given the creation of the United Network for Organ Sharing (UNOS) database in 1986, it was difficult to accrue data on long-term survivors until recently. This study characterizes factors impacting lung transplant survival beyond 20 years, conditional to 1-year survival.
METHODS: Lung transplant recipients listed in UNOS from 1987 to 2002 who survived to 1 post-transplant year were reviewed. Kaplan-Meier and adjusted Cox regression analyses were performed at 20 and 10 years to identify risk factors associated with long-term outcomes independent of their short-term effects.
RESULTS: A total of 6,172 recipients were analyzed, including 472 (7.6%) recipients who lived 20+ years. Factors associated with increased likelihood of 20-year survival were female-to-female gender match, recipient age 25-44, waitlist time >1 year, human leukocyte antigen (HLA) mismatch level 3, and donor cause of death: head trauma. Factors associated with decreased 20-year survival included recipient age ≥55, chronic obstructive pulmonary disease/emphysema (COPD/E) diagnosis, donor smoking history >20 pack-years, unilateral transplant, blood groups O&AB, recipient glomerular filtration rate (GFR)/min, and donor GFR 20-29 mL/min.
CONCLUSIONS: This is the first study identifying factors associated with multiple-decade survival following lung transplant in the United States. Despite its challenges, long-term survival is possible and more likely in younger females in good waitlist condition without COPD/E who receive a bilateral allograft from a non-smoking, gender-matched donor of minimal HLA mismatch. Further analysis of the molecular and immunologic implications of these conditions are warranted.
Keywords
Long-term survival, bronchiolitis obliterans, bilateral transplant, gender matching
Published Open-Access
yes
Recommended Citation
Miggins, John James; Reul, Ross M; Barrett, Spencer; et al., "Twenty-Year Survival Following Lung Transplantation" (2023). Faculty and Staff Publications. 910.
https://digitalcommons.library.tmc.edu/baylor_docs/910
Included in
Biochemistry, Biophysics, and Structural Biology Commons, Medical Sciences Commons, Pulmonology Commons, Respiratory Tract Diseases Commons