Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Pusan National University School of Medicine, Transplantation Research Center, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea.
Department of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea.
Clin Transplant. 2024 Sep;38(9):e15299. doi: 10.1111/ctr.15299.
There is a lack of information on the waitlist performance and post-transplant outcomes of lung transplants in elderly recipients in Korea.
We retrospectively reviewed and analyzed data from the Korean Network for Organ Sharing database between March 2010 and August 2023.
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 (χ = 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 (χ = 9.056, p = .029).
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.
韩国缺乏有关老年肺移植受者在等待名单上的表现和移植后结果的信息。
我们回顾性分析了 2010 年 3 月至 2023 年 8 月期间韩国器官共享网络数据库中的数据。
在研究期间，共有 2574 名患者被列入肺移植名单，其中 511 名（19.9%）年龄超过 65 岁。其中，188 名（36.8%）患者接受了移植，而 184 名（36%）患者在数据提取时未接受移植就已去世。等待名单上最常见的基础疾病是特发性肺纤维化，占 68.1%。与非老年患者相比，老年患者的 1 年生存率显著降低（65.4%对 75.4%；p=0.004）。在多变量 Cox 分析中，年龄较大（风险比[HR]，1.49；95%置信区间[CI]，1.14-1.97；p=0.004）和登记时的高紧急状态（HR，1.83；95%CI，1.40-2.40；p<0.001）与移植后 1 年死亡率显著相关。Kaplan-Meier 曲线显示，根据登记时的紧急状态，移植后死亡率存在显著差异（χ2=8.302，p=0.016）。即使在移植时具有相同的高度紧急情况，根据列表时的情况，也观察到不同的预后（χ2=9.056，p=0.029）。
与非老年成年人相比，老年患者的移植结果更差，登记时的高度紧急状态被确定为显著的危险因素。准备不足的高度紧急移植与不良结局相关。
