Twenty-Year Survival Following Lung Transplantation

Authors

John James Miggins
Ross M Reul
Spencer Barrett
Abbas Rana
Ahmed Alnajar
Jordan Dunson
Alexis Shafii
Puneet Garcha
John Goss
Gabriel Loor

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

Published Open-Access

yes

Keywords

Long-term survival, bronchiolitis obliterans, bilateral transplant, gender matching

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.

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