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OBJECTIVES Debate continues on whether a bilateral (BLT) or a single lung transplantation (SLT) is preferred for patients with end-stage chronic obstructive pulmonary disease (COPD). The purpose of this study is to examine the interplay between patient age and transplant type on survival outcomes. METHODS We performed a retrospective study of lung transplants for COPD at our centre from February 2012 to March 2020 (n = 186). Demographics and clinical parameters were compared between patients based on their age (≤65 vs >65 years old) and type of transplant (single vs bilateral). Cox proportional hazards regression was also performed. P-values <0.05 were considered significant. RESULTS Of the 186 patients with COPD who received lung transplants, 71 (38.2%) received BLTs and 115 (61.8%) received SLTs. There was no significant difference in survival outcomes when looking at patients with single versus BLTs (P = 0.870). There was also no difference in survival between the 2 age groups ≤65 versus > 65 years (P = 0.723). The Cox model itself also did not show a statistically significant improvement in survival outcomes (P = 0.126). CONCLUSIONS Lung transplant outcomes in patients with end-stage COPD demonstrated non-inferior results in patients with an SLT compared to patients with a BLT. When we compared the age groups, neither transplant type showed superior survival benefits, suggesting there may be some utility in an SLT in younger recipients.

Table 1. (continued) Rectum 8 (44.4) Transverse Colon 2 (11.1) Ascending Colon 1 (5.6) Appendiceal Orifice 6 (33.3) Body of Stomach 1 (5.6) Mean Procedure Time 1/-SD, min 42.1 1/-14.3 Technical success, n518 (n, %) Yes 17 (94.4) No 1 (0.06) Clinical success, n517 (n, %) Yes 15 (88.2) No 2 (12.8) Pathohistology of the Retrieved Specimen, n517 (n, %) Adenoma with Low Grade Dysplasia 5 (29.4) Sessile Serrated Lesion 3 (17.6) Adenocarcinoma 3 (17.6) Neuroendocrine Neoplasia 2 (11.8) Other 4 (23.5) S1164

transplant (p=0.356, Figure 1). Short term outcomes demonstrated that a significantly higher number of patients with S were intubated at 72 hours post-transplantation (p=0.005). However, there was no difference in the use of inhaled nitric oxide, extracorporeal membrane oxygenation, PaO 2 , or FiO 2 at 72 hours after transplantation between the two groups. The effect of pulmonary hypertension (PH) at the time of transplant was analyzed in patients with S (n=273) and pulmonary fibrosis not due to S (n=10,400). There was no significant difference in survival between these two groups (p=0.109). Finally, there was no difference in survival between S patients with (n=286) and without PH (n=90, p=0.527). Conclusion:The results of this analysis suggest that selected patients with scleroderma have equivalent survival outcomes when compared to patients with non-scleroderma autoimmune disease and other thoracic diagnoses. Despite a selection bias, the data support favorable outcomes after lung transplant in patients with scleroderma. Therefore, a diagnosis of scleroderma should not be a deterrent to lung transplantation.

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Introduction: As the prevalence of heart failure increases by age, it is critical we understand the role of heart transplantation (HTx) in older patients. Recent long term studies have indicated no difference in HTx outcomes between recipients 70 years or older and those ages 60-69. But these studies included data from the 1980-90s, introducing significant variance due poorer outcomes across age groups in that era. We analyzed the most recent United Network for Organ Sharing (UNOS) database, stratified by time frames before and after 2000, to demonstrate this statistical discrepancy and derive a more representative comparison of modern survival by age group. Hypothesis: HTx recipients 70+ years old may not actually have comparable survival to those 60-69 years of age, when assessing more recent HTx data. Methods: All UNOS HTx recipients over 60 years of age (n=20,446) were divided into 2 cohorts: those 60-69 and those ≥70 years old, which were analyzed over two time frames: transplant date 1987-1999 and 2000-2019. Demographic data (gender, ethnicity, BMI) as well as peri-operative factors (ICU stay, ischemic time, and length of stay) were evaluated for significance using Chi-Squared and H-Tests as appropriate. Kaplan-Meier Curve with log-rank tests were used to assess 10 year survival outcomes. Results: 19,129 patients were 60-69 years old, and 1,317 were ≥70 years old, with mean ages of 64.0±2.7 and 71.3±1.6 years respectively. The distribution of demographic and peri-operative factors was significantly different between the cohorts, with p<0.05 for values. Survival analysis indicated no significance in the earlier timeframe (1987-1999) with p=0.341, but indicated significance in the later timeframe (2000-2019), with p=0.004. Conclusion: The results indicate that since 2000, recipients 60-69 years of age have better 10- year post transplant survival than older recipients, a relationship previously obscured by worse outcomes in early data.