Respiratory Institute, Cleveland Clinic, Cleveland, OH.
The Respiratory Institute, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH.
Chest. 2020 Apr;157(4):907-915. doi: 10.1016/j.chest.2019.06.042. Epub 2019 Aug 13.
Age has been implicated as a factor in the plateau of long-term survival after lung transplant.
We used data from the Scientific Registry of Transplant Recipients to identify all recipients of lung transplant aged ≥18 years of age between January 1, 2006, and February 19, 2015. A total of 14,253 patients were included in the analysis. Survival was estimated using a nonproportional hazard model and random-survival forest methodology was used to examine risk factors for death. Final selection of model variables was performed using bootstrap aggregation. Age was analyzed as both a continuous and categorical variable (age <30, 30-55, and >55 years). Risk factors for death were obtained for the entire cohort and additional age-specific risk factors were identified for each age category.
The median age at transplant was 59 years. There were 1,098 (7.7%) recipients <30 years, 4,201 (29.5%) 30 to 55 years, and 8,954 (62.8%) >55 years of age. Age was the most significant risk factor for death at all time-points following transplant and its impact becomes more prominent as time from transplant increases. Risk factors for death for all patients included extremes of age, higher creatinine, single lung transplant, hospitalization before transplant, and increased bilirubin. Risk factors for death differed by age with social determinants of health disproportionately affecting survival for those in the youngest age category.
The youngest and oldest adult recipients experienced the lowest posttransplant survival through divergent pathways that may present opportunities for intervention to improve survival after lung transplant.
年龄是影响肺移植后长期生存平台的一个因素。
我们使用来自移植受者科学登记处的数据，确定了 2006 年 1 月 1 日至 2015 年 2 月 19 日期间年龄≥18 岁的所有肺移植受者。共纳入 14253 例患者进行分析。采用非比例风险模型估计生存率，并采用随机生存森林方法检查死亡的危险因素。采用引导聚集法对模型变量进行最终选择。年龄既作为连续变量又作为分类变量（年龄<30、30-55 和>55 岁）进行分析。获得了整个队列的死亡危险因素，并为每个年龄组确定了额外的年龄特异性危险因素。
移植时的中位年龄为 59 岁。有 1098 例（7.7%）患者<30 岁，4201 例（29.5%）为 30-55 岁，8954 例（62.8%）>55 岁。年龄是移植后所有时间点死亡的最重要危险因素，其影响随着移植后时间的延长而更加显著。所有患者死亡的危险因素包括年龄极端、肌酐升高、单肺移植、移植前住院和胆红素升高。死亡的危险因素因年龄而异，健康的社会决定因素对最年轻年龄组的生存产生了不成比例的影响。
最年轻和最年长的成年受者经历了移植后最低的生存，这可能为改善肺移植后的生存提供了干预机会。
