title: Lung transplantation in patients 70 years old or older: have outcomes changed after implementation of the lung allocation score?
abstract: OBJECTIVE
  The objective of the present study was to evaluate whether the outcomes of lung transplantation in patients aged 70 years or older have changed after implementation of the lung allocation score in May 2005.
  
  
  METHODS
  Patients aged 70 years or older undergoing primary lung transplantation from 1995 to 2009 were identified from the United Network for Organ Sharing registry. The primary stratification was the pre-lung allocation score era versus lung allocation score era. Risk-adjusted multivariate Cox regression and Kaplan-Meier analyses were conducted to evaluate the effect of age 70 years or older on 1-year post-transplant mortality compared with a reference cohort of patients aged 60 to 69 years.
  
  
  RESULTS
  Of the overall 15,726 adult lung transplantation patients in the study period, 225 (1.4%) were 70 years old or older and 4634 (29.5%) were 60 to 69 years old. The patients aged 70 years or older were a larger cohort of overall lung transplantation patients in the lung allocation score era compared with before the lung allocation score era (3.1% vs 0.3%, P < .001). In the risk-adjusted Cox analysis, age 70 years or older was a significant risk factor for 1-year post-lung transplantation mortality in the pre-lung allocation score era (hazard ratio, 2.00; 95% confidence interval, 1.10-3.62, P = .02) but not in the lung allocation score era (hazard ratio, 1.02; 95% confidence interval, 0.71-1.46; P = .92). Similarly, Kaplan-Meier 1-year survival was significantly reduced in patients 70 years old or older versus 60 to 69 years old in the pre-lung allocation score era (56.7% vs 76.3%, P = .006) but not in the lung allocation score era (79.0% vs 80.0%, P = .72).
  
  
  CONCLUSIONS
  Recipients aged 70 years or older were a larger proportion of overall lung transplantation patients after implementation of the lung allocation score. Although associated with significantly increased post-lung transplantation mortality in the pre-lung allocation score era, age 70 years or older is currently associated with outcomes comparable to those of patients aged 60 to 69 years. Therefore, age 70 years or older should not serve as an absolute contraindication to lung transplantation in the lung allocation score era.
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
authors.forename: Arman
authors.initials: A
authors.lastname: Kilic
authors.forename: Christian A
authors.initials: CA
authors.lastname: Merlo
authors.forename: John V
authors.initials: JV
authors.lastname: Conte
authors.forename: Ashish S
authors.initials: AS
authors.lastname: Shah
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000075202:Contraindications; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016040:Lung Transplantation / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018579:Patient Selection; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D016016:Proportional Hazards Models; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult