Contemporary analysis of early outcomes after lung transplantation in the elderly using a national registry

Awori J. Hayanga, Jonathan K. Aboagye, Heather E. Hayanga, Matthew Morrell, Lynn Huffman, Norihisa Shigemura, Jay K. Bhama, Jonathan D'Cunha, Christian A. Bermudez

Research output: Contribution to journalArticle

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Abstract

Background With an increasing number of potential recipients and a comparatively static number of donors, lung transplantation (LT) in the elderly has come under significant scrutiny. Previous studies have been limited by single-center experiences with small population sizes and often mixed results. Using a national registry, we sought to evaluate the following: (1) differences in survival outcomes in septuagenarians compared with sexagenarians; and (2) the effect of temporal trends on the development of other comorbidities in this population. Methods We analyzed the Scientific Registry of Transplant Recipients (SRTR) data files from the United Network for Organ Sharing (UNOS) database to identify recipients who underwent LT between the years 2000 and 2013. The study period was divided into two equal eras. Using Kaplan-Meier analysis, we compared the 30-day, 3-month, 1-year, 3-year and 5-year patient survival between septuagenarians and sexagenarians in both eras. Separate multivariate analyses were performed to estimate the risk of renal failure, risk of rejection and length of hospital stay (LOS) post-LT in each of these time periods. Results A total of 6,596 patients were identified comprising 1,726 (26.2%) during 2000 to 2005 and 4,870 (73.8%) during 2006 to 2012. In the "early era," 32 (1.9%) septuagenarians and 1,694 (98.1%) sexagenarians underwent LT, whereas 543 (11.1%) septuagenarians and 4,327 (88.9%) sexagenarians underwent transplantation in the "latter era." A comparison of patient survival between the two groups in the early era revealed no difference at 30 days (95.7% vs 93.8%, p = 0.65). However, 3-month (91.2% vs 75%, p = 0.04) and 1-year patient survival (79.5% vs 62.5%, p = 0.048) were both lower in the septuagenarian group. In the later era, however, there were no differences in 30-day (96.2% vs 96.8, p = 0.5), 3-month (92.7% vs 91.9%, p = 0.56) or 1-year (81.7% vs 78.6%, p = 0.12) patient survival between the two age groups. Survival rates at 3 years (63.7% vs 49.3%, p < 0.001) and 5 years (47.5% vs 28.2%, p < 0.001) were each significantly lower in the septuagenarian group. Conclusion Overall, LT outcomes for the elderly have improved significantly over time and early outcomes in the modern era rival those found in younger recipients.

Original languageEnglish (US)
Pages (from-to)182-188
Number of pages7
JournalJournal of Heart and Lung Transplantation
Volume34
Issue number2
DOIs
StatePublished - Jan 1 2015

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Lung Transplantation
Registries
Survival
Length of Stay
Information Storage and Retrieval
Kaplan-Meier Estimate
Population Density
Renal Insufficiency
Comorbidity
Multivariate Analysis
Survival Rate
Age Groups
Transplantation
Tissue Donors
Databases
Population

Keywords

  • contemporary
  • early outcomes
  • elderly
  • lung transplantation
  • national

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Transplantation

Cite this

Contemporary analysis of early outcomes after lung transplantation in the elderly using a national registry. / Hayanga, Awori J.; Aboagye, Jonathan K.; Hayanga, Heather E.; Morrell, Matthew; Huffman, Lynn; Shigemura, Norihisa; Bhama, Jay K.; D'Cunha, Jonathan; Bermudez, Christian A.

In: Journal of Heart and Lung Transplantation, Vol. 34, No. 2, 01.01.2015, p. 182-188.

Research output: Contribution to journalArticle

Hayanga, AJ, Aboagye, JK, Hayanga, HE, Morrell, M, Huffman, L, Shigemura, N, Bhama, JK, D'Cunha, J & Bermudez, CA 2015, 'Contemporary analysis of early outcomes after lung transplantation in the elderly using a national registry', Journal of Heart and Lung Transplantation, vol. 34, no. 2, pp. 182-188. https://doi.org/10.1016/j.healun.2014.09.028
Hayanga, Awori J. ; Aboagye, Jonathan K. ; Hayanga, Heather E. ; Morrell, Matthew ; Huffman, Lynn ; Shigemura, Norihisa ; Bhama, Jay K. ; D'Cunha, Jonathan ; Bermudez, Christian A. / Contemporary analysis of early outcomes after lung transplantation in the elderly using a national registry. In: Journal of Heart and Lung Transplantation. 2015 ; Vol. 34, No. 2. pp. 182-188.
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abstract = "Background With an increasing number of potential recipients and a comparatively static number of donors, lung transplantation (LT) in the elderly has come under significant scrutiny. Previous studies have been limited by single-center experiences with small population sizes and often mixed results. Using a national registry, we sought to evaluate the following: (1) differences in survival outcomes in septuagenarians compared with sexagenarians; and (2) the effect of temporal trends on the development of other comorbidities in this population. Methods We analyzed the Scientific Registry of Transplant Recipients (SRTR) data files from the United Network for Organ Sharing (UNOS) database to identify recipients who underwent LT between the years 2000 and 2013. The study period was divided into two equal eras. Using Kaplan-Meier analysis, we compared the 30-day, 3-month, 1-year, 3-year and 5-year patient survival between septuagenarians and sexagenarians in both eras. Separate multivariate analyses were performed to estimate the risk of renal failure, risk of rejection and length of hospital stay (LOS) post-LT in each of these time periods. Results A total of 6,596 patients were identified comprising 1,726 (26.2{\%}) during 2000 to 2005 and 4,870 (73.8{\%}) during 2006 to 2012. In the {"}early era,{"} 32 (1.9{\%}) septuagenarians and 1,694 (98.1{\%}) sexagenarians underwent LT, whereas 543 (11.1{\%}) septuagenarians and 4,327 (88.9{\%}) sexagenarians underwent transplantation in the {"}latter era.{"} A comparison of patient survival between the two groups in the early era revealed no difference at 30 days (95.7{\%} vs 93.8{\%}, p = 0.65). However, 3-month (91.2{\%} vs 75{\%}, p = 0.04) and 1-year patient survival (79.5{\%} vs 62.5{\%}, p = 0.048) were both lower in the septuagenarian group. In the later era, however, there were no differences in 30-day (96.2{\%} vs 96.8, p = 0.5), 3-month (92.7{\%} vs 91.9{\%}, p = 0.56) or 1-year (81.7{\%} vs 78.6{\%}, p = 0.12) patient survival between the two age groups. Survival rates at 3 years (63.7{\%} vs 49.3{\%}, p < 0.001) and 5 years (47.5{\%} vs 28.2{\%}, p < 0.001) were each significantly lower in the septuagenarian group. Conclusion Overall, LT outcomes for the elderly have improved significantly over time and early outcomes in the modern era rival those found in younger recipients.",
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AU - Hayanga, Awori J.

AU - Aboagye, Jonathan K.

AU - Hayanga, Heather E.

AU - Morrell, Matthew

AU - Huffman, Lynn

AU - Shigemura, Norihisa

AU - Bhama, Jay K.

AU - D'Cunha, Jonathan

AU - Bermudez, Christian A.

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N2 - Background With an increasing number of potential recipients and a comparatively static number of donors, lung transplantation (LT) in the elderly has come under significant scrutiny. Previous studies have been limited by single-center experiences with small population sizes and often mixed results. Using a national registry, we sought to evaluate the following: (1) differences in survival outcomes in septuagenarians compared with sexagenarians; and (2) the effect of temporal trends on the development of other comorbidities in this population. Methods We analyzed the Scientific Registry of Transplant Recipients (SRTR) data files from the United Network for Organ Sharing (UNOS) database to identify recipients who underwent LT between the years 2000 and 2013. The study period was divided into two equal eras. Using Kaplan-Meier analysis, we compared the 30-day, 3-month, 1-year, 3-year and 5-year patient survival between septuagenarians and sexagenarians in both eras. Separate multivariate analyses were performed to estimate the risk of renal failure, risk of rejection and length of hospital stay (LOS) post-LT in each of these time periods. Results A total of 6,596 patients were identified comprising 1,726 (26.2%) during 2000 to 2005 and 4,870 (73.8%) during 2006 to 2012. In the "early era," 32 (1.9%) septuagenarians and 1,694 (98.1%) sexagenarians underwent LT, whereas 543 (11.1%) septuagenarians and 4,327 (88.9%) sexagenarians underwent transplantation in the "latter era." A comparison of patient survival between the two groups in the early era revealed no difference at 30 days (95.7% vs 93.8%, p = 0.65). However, 3-month (91.2% vs 75%, p = 0.04) and 1-year patient survival (79.5% vs 62.5%, p = 0.048) were both lower in the septuagenarian group. In the later era, however, there were no differences in 30-day (96.2% vs 96.8, p = 0.5), 3-month (92.7% vs 91.9%, p = 0.56) or 1-year (81.7% vs 78.6%, p = 0.12) patient survival between the two age groups. Survival rates at 3 years (63.7% vs 49.3%, p < 0.001) and 5 years (47.5% vs 28.2%, p < 0.001) were each significantly lower in the septuagenarian group. Conclusion Overall, LT outcomes for the elderly have improved significantly over time and early outcomes in the modern era rival those found in younger recipients.

AB - Background With an increasing number of potential recipients and a comparatively static number of donors, lung transplantation (LT) in the elderly has come under significant scrutiny. Previous studies have been limited by single-center experiences with small population sizes and often mixed results. Using a national registry, we sought to evaluate the following: (1) differences in survival outcomes in septuagenarians compared with sexagenarians; and (2) the effect of temporal trends on the development of other comorbidities in this population. Methods We analyzed the Scientific Registry of Transplant Recipients (SRTR) data files from the United Network for Organ Sharing (UNOS) database to identify recipients who underwent LT between the years 2000 and 2013. The study period was divided into two equal eras. Using Kaplan-Meier analysis, we compared the 30-day, 3-month, 1-year, 3-year and 5-year patient survival between septuagenarians and sexagenarians in both eras. Separate multivariate analyses were performed to estimate the risk of renal failure, risk of rejection and length of hospital stay (LOS) post-LT in each of these time periods. Results A total of 6,596 patients were identified comprising 1,726 (26.2%) during 2000 to 2005 and 4,870 (73.8%) during 2006 to 2012. In the "early era," 32 (1.9%) septuagenarians and 1,694 (98.1%) sexagenarians underwent LT, whereas 543 (11.1%) septuagenarians and 4,327 (88.9%) sexagenarians underwent transplantation in the "latter era." A comparison of patient survival between the two groups in the early era revealed no difference at 30 days (95.7% vs 93.8%, p = 0.65). However, 3-month (91.2% vs 75%, p = 0.04) and 1-year patient survival (79.5% vs 62.5%, p = 0.048) were both lower in the septuagenarian group. In the later era, however, there were no differences in 30-day (96.2% vs 96.8, p = 0.5), 3-month (92.7% vs 91.9%, p = 0.56) or 1-year (81.7% vs 78.6%, p = 0.12) patient survival between the two age groups. Survival rates at 3 years (63.7% vs 49.3%, p < 0.001) and 5 years (47.5% vs 28.2%, p < 0.001) were each significantly lower in the septuagenarian group. Conclusion Overall, LT outcomes for the elderly have improved significantly over time and early outcomes in the modern era rival those found in younger recipients.

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