Analysis of the waitlist performance and post-transplant outcomes of lung transplant in elderly recipients in Korea: A nationwide cohort study

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation Pub Date : 2024-09-13 DOI:10.1111/ctr.15299

Jin Ho Jang, Do Hyung Kim, Bong Soo Son, Jong Myung Park, Min Wook So, Daesup Lee, Doosoo Jeon, Yun Seong Kim, Woo Hyun Cho, Hye Ju Yeo

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Abstract

Background

There is a lack of information on the waitlist performance and post-transplant outcomes of lung transplants in elderly recipients in Korea.

Methods

We retrospectively reviewed and analyzed data from the Korean Network for Organ Sharing database between March 2010 and August 2023.

Results

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 (χ² = 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 (χ² = 9.056, p = .029).

Conclusion

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.

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韩国老年肺移植受者的候诊情况和移植后效果分析：全国性队列研究

背景缺乏有关韩国老年肺移植受者的候诊情况和移植后预后的信息。方法我们回顾并分析了韩国器官共享网络数据库中 2010 年 3 月至 2023 年 8 月期间的数据。结果在研究期间，共有 2574 名患者被列入肺移植名单，其中 511 人（19.9%）年龄超过 65 岁。其中，188 名患者（36.8%）接受了移植手术，184 名患者（36%）在数据提取时未接受移植手术而去世。候选名单中最常见的基础疾病是特发性肺纤维化，占 68.1%。与非老年人相比，老年人的1年存活率明显较低（65.4% vs. 75.4%; p = .004）。在多变量 Cox 分析中，老年人（危险比 [HR]，1.49；95% CI，1.14-1.97；p = .004）和登记时的高度紧急状态（HR，1.83；95% CI，1.40-2.40；p <.001）与移植后 1 年死亡率明显相关。Kaplan-Meier 曲线显示，根据登记时的紧急状况，移植后死亡率存在显著差异（χ2 = 8.302，p = .016）。即使在移植时情况同样紧急，但根据入院时情况的不同，预后也不同（χ2 = 9.056，p = .029）。结论老年人的移植结果比非老年人差，登记时的高度紧急状况是一个重要的风险因素。无准备、高度紧急的移植与不良预后有关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.