Extremes of Age Decrease Survival in Adults After Lung Transplant.
Adult
Age Factors
Female
Humans
Lung Diseases
/ epidemiology
Lung Transplantation
/ methods
Male
Middle Aged
Proportional Hazards Models
Registries
/ statistics & numerical data
Risk Assessment
/ methods
Risk Factors
Social Determinants of Health
/ statistics & numerical data
Survival Rate
Tissue and Organ Procurement
/ methods
Transplant Recipients
/ statistics & numerical data
United States
/ epidemiology
lung transplant
lung transplant outcomes
organ allocation
random survival forest
Journal
Chest
ISSN: 1931-3543
Titre abrégé: Chest
Pays: United States
ID NLM: 0231335
Informations de publication
Date de publication:
04 2020
04 2020
Historique:
received:
16
04
2019
revised:
11
06
2019
accepted:
29
06
2019
pubmed:
17
8
2019
medline:
10
2
2021
entrez:
17
8
2019
Statut:
ppublish
Résumé
Age has been implicated as a factor in the plateau of long-term survival after lung transplant. We used data from the Scientific Registry of Transplant Recipients to identify all recipients of lung transplant aged ≥18 years of age between January 1, 2006, and February 19, 2015. A total of 14,253 patients were included in the analysis. Survival was estimated using a nonproportional hazard model and random-survival forest methodology was used to examine risk factors for death. Final selection of model variables was performed using bootstrap aggregation. Age was analyzed as both a continuous and categorical variable (age <30, 30-55, and >55 years). Risk factors for death were obtained for the entire cohort and additional age-specific risk factors were identified for each age category. The median age at transplant was 59 years. There were 1,098 (7.7%) recipients <30 years, 4,201 (29.5%) 30 to 55 years, and 8,954 (62.8%) >55 years of age. Age was the most significant risk factor for death at all time-points following transplant and its impact becomes more prominent as time from transplant increases. Risk factors for death for all patients included extremes of age, higher creatinine, single lung transplant, hospitalization before transplant, and increased bilirubin. Risk factors for death differed by age with social determinants of health disproportionately affecting survival for those in the youngest age category. The youngest and oldest adult recipients experienced the lowest posttransplant survival through divergent pathways that may present opportunities for intervention to improve survival after lung transplant.
Sections du résumé
BACKGROUND
Age has been implicated as a factor in the plateau of long-term survival after lung transplant.
METHODS
We used data from the Scientific Registry of Transplant Recipients to identify all recipients of lung transplant aged ≥18 years of age between January 1, 2006, and February 19, 2015. A total of 14,253 patients were included in the analysis. Survival was estimated using a nonproportional hazard model and random-survival forest methodology was used to examine risk factors for death. Final selection of model variables was performed using bootstrap aggregation. Age was analyzed as both a continuous and categorical variable (age <30, 30-55, and >55 years). Risk factors for death were obtained for the entire cohort and additional age-specific risk factors were identified for each age category.
RESULTS
The median age at transplant was 59 years. There were 1,098 (7.7%) recipients <30 years, 4,201 (29.5%) 30 to 55 years, and 8,954 (62.8%) >55 years of age. Age was the most significant risk factor for death at all time-points following transplant and its impact becomes more prominent as time from transplant increases. Risk factors for death for all patients included extremes of age, higher creatinine, single lung transplant, hospitalization before transplant, and increased bilirubin. Risk factors for death differed by age with social determinants of health disproportionately affecting survival for those in the youngest age category.
CONCLUSIONS
The youngest and oldest adult recipients experienced the lowest posttransplant survival through divergent pathways that may present opportunities for intervention to improve survival after lung transplant.
Identifiants
pubmed: 31419403
pii: S0012-3692(19)31449-7
doi: 10.1016/j.chest.2019.06.042
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
907-915Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2019 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.