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Outcomes of Lung Transplant Recipients 70 and Over
Abstracts 835 Survival Analysis Evaluating Extracorporeal Membrane Oxygenation and Mechanical Ventilation as a Bridge to Lung Transplantation Y. Xia, J. Lee, H. Seethamraju, S. Scheinin and S.J. Forest. Montefiore Medical Center, Bronx, NY. Purpose: Extracorporeal membrane oxygenation (ECMO) is underutilized as bridge to lung transplantation (LTx) when compared to conventional mechanical ventilation (MV) in patients with end-stage lung failure. We sought to evaluate short-term outcomes in lung transplant recipients requiring preoperative advanced life support. Methods: We retrospectively reviewed UNOS database to identify primary adult LTx recipients (1/2008 to 6/2017) who had no support (NO), MV, ECMO or both MV and ECMO (MVE) prior to LTx. Baseline characteristics were compared via chi-square and ANOVA. One-year survival was compared among the four groups using the Kaplan-Meier method and multivariate Cox proportional hazards regression for one-year survival was conducted to adjust for potential confounders. Results: Of 16,392 recipients, there were 204 (1.2%) ECMO, 719 (4.4%) MV, and 350 (2.1%) MVE prior to transplant, with survival depicted in Fig 1. The NO cohort was older (57y) compared to MV (52y), ECMO (48y), and MVE (45y), p<.01. A majority of recipients were male, 54-60%, in each cohort. COPD was most common in the NO cohort (25%) compared to ECMO (5%), MV (17%), and MVE (1%), p<.01. IPF was the single most common diagnosis in each group, NO (37%), ECMO (39%), MV (34%), and MVE (39%). Ischemic time was longer in patients supported with MV (5.5h), ECMO (5.8h), and MVE (6.1h) compared to NO cohort (5.1h), p<.01. Single lung transplant was most common in the NO group (32%) compared to the others (6-16%), p<.01. On multivariate analysis, MV (HR 1.62, p<0.01) and MVE (HR=2.25, p<0.01) were significantly associated with worse survival while ECMO (HR 1.28, p<0.22) was not. Conclusion: Short-term survival utilizing ECMO as a bridge to LTx is favorable. Further evaluation into patient selection and direct comparison to conventional MV is warranted.
836 Lung Transplant Listing of Idiopathic Pulmonary Fibrosis Patients at Pulmonary Fibrosis Care Centers J. Mooney,1 J. Moore,2 R. Raj,1 and G. Dhillon.1 1Department of Medicine, Stanford University School of Medicine, Stanford, CA; and the 2Department of Biostatistics, University of Michigan, Ann Arbor, MI. Purpose: Idiopathic pulmonary fibrosis (IPF) is a progressive fibrotic interstitial lung disease with lung transplant recommended in medically appropriate patients with advanced disease. Although outcomes for IPF patients on the waitlist are well described, there is limited data on which IPF patients make it to the transplant waitlist, including whether transplant eligible patients are listed timely for lung transplant. The aim of this study is to identify the proportion of IPF patients with advanced disease, defined as GAP stage of 3, who undergo lung transplant listing within 6 months and to compare characteristics between those listed and not listed. A GAP stage of 3 was used to represent advanced disease given its association with a mortality estimate of 39% at 1-year and 62% at 2-years.
S335 Methods: IPF patients were identified within the Pulmonary Fibrosis Foundation patient registry, which includes clinical, demographic, and socioeconomic information submitted from over 40 pulmonary fibrosis specialty care centers across the United Sites. IPF patients with <6 months of follow-up data, age>75, BMI≥35, active tobacco smoking, congestive heart failure, non-skin cancer, and/or liver cirrhosis were excluded from analysis. Characteristics were compared between IPF patients listed and not listed for lung transplant within 6 months and stratified by GAP stage. Results: There were 595 IPF patients identified who met inclusion criteria including 36 listed for lung transplant and 559 not listed for lung transplant. 55.6% of listed patients were on anti-fibrotic therapy and 50% were attending pulmonary rehab. Patients listed for lung transplant had a lower median FVC, lower DLCO, lower 6-minute walk distance, greater oxygen requirement, and were more likely to have Medicare insurance and live closer to a transplant center than those not listed. There were 410 IPF patients (77.5%) with GAP stage 3 disease of which 386 (94%) were not listed for lung transplant. Of these 386 patients, 10.9% were age <65 years, 37.3% were 65-69 years, and 51.8% were 70-74 years. Conclusion: Within pulmonary fibrosis specialty care centers, there are a large number of IPF patients with GAP stage 3 disease who are not listed for lung transplant, including those older and younger than 70. Further understanding of the potential barriers to timely lung transplant listing is needed. 837 Outcomes of Lung Transplant Recipients 70 and Over S. Elnahas,1 P. Kang,2 S. Biswas Roy,1 M. Olson,3 M.A. Smith,1 and R. Walia.1 1Norton Thoracic Institute, St. Joseph's Hospital & Medical Center, Phoenix, AZ; 2University of Arizona - Phoenix Campus, Phoenix, AZ; and the 3Grand Canyon University, Phoenix, AZ. Purpose: Lung transplant (LTx) in older adults has been gaining attention as average life expectancy continues to rise. Long-term survival of LTx recipients ≥70 is worse than in younger recipients, but the question remains: Is advanced age (≥70 years) reason to withhold life-prolonging treatment if a patient’s risk profile is otherwise acceptable? Methods: We retrospectively reviewed charts of patients who underwent LTx between 2012 and 2016. Patients were divided into groups according to age: Group A (< 65 years), B (65-69 years), and C (≥70 years). Survival rates were calculated using the Kaplan-Meier method and Cox regression. Results: Of the 375 patients who underwent LTx during the study period, 221 (59%) were in Group A, 109 (29%) were in Group B, and 45 (12%) were in Group C. Group C was mostly men (37/45 [82%]; p=0.003) and had the highest mean serum creatinine at listing (p=0.02). Compared with Group A, Group C had better forced expiratory volume in one second (FEV1; p<0.001) and forced vital capacity (p=0.03) at listing, were less likely to undergo double LTx (p=0.02), and required fewer blood products during LTx (p=0.007). Group C also had lower incidence of dialysis between LTx and discharge (p=0.04), lower incidence of grade 3 primary graft dysfunction at 72 hours (p=0.04), and at 1-year, FEV1 was better in Group C than in Groups A or B (p=0.07). 1- and 3-year survival were significantly lower in Group B (88.1%, 66.5%) than in Group A (96.4%, 77.9%; p=0.002, p=0.01). 1- and 3-year survival were also significantly lower in Group C (88.9%, 61.4%) than in Group A (p=0.02, p=0.019). Groups B and C had comparable 1- and 3-year survival (p=0.96, p=0.74). Conclusion: LTx in patients over 70 can have acceptable clinical outcomes. 1- and 3-year survival were comparable between patients ages 6569 and ≥70, but survival significantly decreased in patients over 65. Age of 70 or older should not be an absolute contraindication to LTx if the patient’s risk profile is otherwise acceptable.
836 Lung Transplant Listing of Idiopathic Pulmonary Fibrosis Patients at Pulmonary Fibrosis Care Centers J. Mooney,1 J. Moore,2 R. Raj,1 and G. Dhillon.1 1Department of Medicine, Stanford University School of Medicine, Stanford, CA; and the 2Department of Biostatistics, University of Michigan, Ann Arbor, MI. Purpose: Idiopathic pulmonary fibrosis (IPF) is a progressive fibrotic interstitial lung disease with lung transplant recommended in medically appropriate patients with advanced disease. Although outcomes for IPF patients on the waitlist are well described, there is limited data on which IPF patients make it to the transplant waitlist, including whether transplant eligible patients are listed timely for lung transplant. The aim of this study is to identify the proportion of IPF patients with advanced disease, defined as GAP stage of 3, who undergo lung transplant listing within 6 months and to compare characteristics between those listed and not listed. A GAP stage of 3 was used to represent advanced disease given its association with a mortality estimate of 39% at 1-year and 62% at 2-years.
S335 Methods: IPF patients were identified within the Pulmonary Fibrosis Foundation patient registry, which includes clinical, demographic, and socioeconomic information submitted from over 40 pulmonary fibrosis specialty care centers across the United Sites. IPF patients with <6 months of follow-up data, age>75, BMI≥35, active tobacco smoking, congestive heart failure, non-skin cancer, and/or liver cirrhosis were excluded from analysis. Characteristics were compared between IPF patients listed and not listed for lung transplant within 6 months and stratified by GAP stage. Results: There were 595 IPF patients identified who met inclusion criteria including 36 listed for lung transplant and 559 not listed for lung transplant. 55.6% of listed patients were on anti-fibrotic therapy and 50% were attending pulmonary rehab. Patients listed for lung transplant had a lower median FVC, lower DLCO, lower 6-minute walk distance, greater oxygen requirement, and were more likely to have Medicare insurance and live closer to a transplant center than those not listed. There were 410 IPF patients (77.5%) with GAP stage 3 disease of which 386 (94%) were not listed for lung transplant. Of these 386 patients, 10.9% were age <65 years, 37.3% were 65-69 years, and 51.8% were 70-74 years. Conclusion: Within pulmonary fibrosis specialty care centers, there are a large number of IPF patients with GAP stage 3 disease who are not listed for lung transplant, including those older and younger than 70. Further understanding of the potential barriers to timely lung transplant listing is needed. 837 Outcomes of Lung Transplant Recipients 70 and Over S. Elnahas,1 P. Kang,2 S. Biswas Roy,1 M. Olson,3 M.A. Smith,1 and R. Walia.1 1Norton Thoracic Institute, St. Joseph's Hospital & Medical Center, Phoenix, AZ; 2University of Arizona - Phoenix Campus, Phoenix, AZ; and the 3Grand Canyon University, Phoenix, AZ. Purpose: Lung transplant (LTx) in older adults has been gaining attention as average life expectancy continues to rise. Long-term survival of LTx recipients ≥70 is worse than in younger recipients, but the question remains: Is advanced age (≥70 years) reason to withhold life-prolonging treatment if a patient’s risk profile is otherwise acceptable? Methods: We retrospectively reviewed charts of patients who underwent LTx between 2012 and 2016. Patients were divided into groups according to age: Group A (< 65 years), B (65-69 years), and C (≥70 years). Survival rates were calculated using the Kaplan-Meier method and Cox regression. Results: Of the 375 patients who underwent LTx during the study period, 221 (59%) were in Group A, 109 (29%) were in Group B, and 45 (12%) were in Group C. Group C was mostly men (37/45 [82%]; p=0.003) and had the highest mean serum creatinine at listing (p=0.02). Compared with Group A, Group C had better forced expiratory volume in one second (FEV1; p<0.001) and forced vital capacity (p=0.03) at listing, were less likely to undergo double LTx (p=0.02), and required fewer blood products during LTx (p=0.007). Group C also had lower incidence of dialysis between LTx and discharge (p=0.04), lower incidence of grade 3 primary graft dysfunction at 72 hours (p=0.04), and at 1-year, FEV1 was better in Group C than in Groups A or B (p=0.07). 1- and 3-year survival were significantly lower in Group B (88.1%, 66.5%) than in Group A (96.4%, 77.9%; p=0.002, p=0.01). 1- and 3-year survival were also significantly lower in Group C (88.9%, 61.4%) than in Group A (p=0.02, p=0.019). Groups B and C had comparable 1- and 3-year survival (p=0.96, p=0.74). Conclusion: LTx in patients over 70 can have acceptable clinical outcomes. 1- and 3-year survival were comparable between patients ages 6569 and ≥70, but survival significantly decreased in patients over 65. Age of 70 or older should not be an absolute contraindication to LTx if the patient’s risk profile is otherwise acceptable.