title: Lung transplantation for emphysema: impact of age on short- and long-term survival.
abstract: OBJECTIVE
  Overall, emphysema (EMP) is the most common indication for lung transplantation. The majority of patients present with chronic obstructive pulmonary disease (COPD) and less frequently with alpha-1 antitrypsin deficiency (A1ATD). We analysed the results of lung transplants performed for EMP in order to identify the impact of age on short- and long-term outcome.
  
  
  METHODS
  A retrospective analysis was undertaken of the 108 consecutive lung transplants for EMP performed at our institution from November 1992 to August 2013 (77 COPD, 31 A1ATD). Retransplantations were excluded.
  
  
  RESULTS
  The median age was 56 years (range 31-68). Thirty-day mortality rate was 3.7%. One- and 5-year survival rates in COPD and A1ATD recipients were comparable (P = 0.8). The 1- and 5-year survival rates for recipients aged <60 years old were significantly better than the age group of ≥60 years (91 and 79 vs 84 and 54%, P = 0.05). Since 2007, the 1- and 5-year survival for these two age groups were 96 and 92 vs 86 and 44%, respectively, P = 0.04, log-rank test). For the following parameters, we were not able to find any difference to affect survival rates: use of intraoperative extracorporeal membrane oxygenation, waiting list time, sex, graft size reduction, body mass index and diagnosis. In multivariate analysis, age at transplantation (≥60 years old) (HR 2.854; 95% confidence interval (CI) 1.338-6.08, P = 0.008) and unilateral lung transplantation (HR 15.2; 95% CI 3.2-71.9, P = 0.009) were independent risk factors for mortality.
  
  
  CONCLUSIONS
  COPD and A1ATD recipients have similar overall long-term survival. Recipients aged ≥60 years and unilateral lung transplants were risk factors for mortality.
authors.affiliation: Department of Thoracic Surgery, Zurich University Hospital, Zurich, Switzerland ilhan.inci@usz.ch.
authors.forename: Ilhan
authors.initials: I
authors.lastname: Inci
authors.affiliation: Division of Pulmonary Medicine, Zurich University Hospital, Zurich, Switzerland.
authors.forename: Macé
authors.initials: M
authors.lastname: Schuurmans
authors.affiliation: Department of Thoracic Surgery, Zurich University Hospital, Zurich, Switzerland.
authors.forename: Jonas
authors.initials: J
authors.lastname: Ehrsam
authors.affiliation: Department of Thoracic Surgery, Zurich University Hospital, Zurich, Switzerland.
authors.forename: Didier
authors.initials: D
authors.lastname: Schneiter
authors.affiliation: Department of Thoracic Surgery, Zurich University Hospital, Zurich, Switzerland.
authors.forename: Sven
authors.initials: S
authors.lastname: Hillinger
authors.affiliation: Department of Thoracic Surgery, Zurich University Hospital, Zurich, Switzerland.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Jungraithmayr
authors.affiliation: Division of Pulmonary Medicine, Zurich University Hospital, Zurich, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Benden
authors.affiliation: Department of Thoracic Surgery, Zurich University Hospital, Zurich, Switzerland.
authors.forename: Walter
authors.initials: W
authors.lastname: Weder
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D004646:Emphysema / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D016040:Lung Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis
keywords: Age; Emphysema; Lung transplantation; Morbidity; Mortality; Survival