Factors indicative of long-term survival after lung transplantation: A review of 836 10-year survivors

Introduction: Despite 20 years of lung transplantation (LTx), factors influencing long-term survival remain largely unknown. The United Network for Organ Sharing (UNOS) data set provides an opportunity to examine long-term LTx survivors. Methods: We conducted a case-control study embedded within the prospectively collected UNOS LTx cohort to identify 836 adults from 1987 to 1997 who survived ≥10 years after first LTx. LTx patients within the same era and surviving 1 to 5 years served as controls. Multivariable logistic regression with incorporation of spline terms evaluated the odds of being a 10-year survivor. Two separate models were constructed. Model A incorporated pre-operative, operative, and donor-specific factors. Model B incorporated the factors used in Model A with post-operative covariates. Additional outcomes evaluated included hospitalizations for infection, rejection, and bronchiolitis obliterans. Results: Of 4,818 LTx patients from 1987 to 1997, 836 (17.3%) survived ≥10 years with a mean follow-up of 148.8 ± 21.6 months. Mean follow-up for 1,657 controls was 34.0 ± 13.9 months. The distribution of 10-year survivors by disease was cystic fibrosis, 170 (20%); chronic obstructive pulmonary disease, 254 (30%); and idiopathic pulmonary fibrosis, 92 (11%). On multivariable logistic regression, significant factors influencing 10-year survival included age ≤35 years (odds ratio [OR] 1.07, 95% confidence interval [CI], 1.03-1.11; p = 0.01), bilateral LTx (OR. 1.71; 95% CI, 1.25-2.34; p = 0.001), and hospitalizations for infections (OR, 1.40; 95% CI, 1.27-1.54; p < 0.001) and for rejection (OR, 0.55; 95% CI, 0.48-0.65; p < 0.001). Conclusions: Examination of a cohort of long-term LTx survivors in the UNOS data set indicates that bilateral LTx and fewer hospitalizations for rejection may portend improved long-term survival after LTx.