Factors Associated with Prolonged Survival (>15 Years) after Lung Transplantation: Analysis of the ISHLT Registry

Purpose Long- term outcomes after lung transplantation remain suboptimal with the median survival of 6 years. There is a paucity of data about lung transplant recipients with prolonged (>15 years) survival (pLTS). The aim of this study was to examine the prevalence of pLTS and identify their perioperative and post-operative features compared to a contemporary group with shorter survival. Methods The ISHLT Transplant Registry was queried for adult(>=18 years) patients transplanted from 1990-2001 who survived more than 15 years and patients with post-lung transplant survival between 1 and 5 years. We excluded re-transplants, and multiorgan transplants. To understand the prevalence of pLTS, Kaplan Meier method was used to estimate the 15 year post-transplant survival probability. To identify potential predictors of pLTS, peri-transplant characteristics of the two groups were compared using Fisher's Exact Test and Wilcoxon Rank Sum Test. Variables with more than 25% of the data missing were excluded from this analysis. Results A total of 5346 patients were included in the study, 1848 in the pLTS cohort and 3498 in the 1-to-5 year survival cohort. The 15year post-transplant survival probability was 19.5%. Recipient younger age, lower body mass index (BMI), female gender, bilateral transplant as well as donor female gender were associated with pLTS. Blood type and donor age were not associated with pLTS. While overall, most lung transplants were performed in lower volume centers, a higher number pLTS were transplanted in centers performing >25 transplants/year. A higher proportion of cystic fibrosis patients tended to be pLTS. Conclusion Age, BMI, gender, transplant type, transplant center volume, and primary lung disease were associated with long term survival after lung transplant suggesting that these pre-transplant characteristics may be used to build prognostic model for predicting the occurrence of pLTS at the time of transplant.