Impact of renal function on survival in idiopathic pulmonary fibrosis patients 65 years and older undergoing lung transplantation in the United States.

OBJECTIVE

Changes in patient demographics, pharmacotherapies, and allocation systems have increased the number of patients receiving a lung transplant at an older age. This change reflects an increasing number of lung transplant recipients who have idiopathic pulmonary fibrosis.

METHODS

The United Network for Organ Sharing database was used to identify adult lung transplant recipients with and without a primary diagnosis of idiopathic pulmonary fibrosis from January 1, 2005, to March 31, 2025. Patient trends and 5-year survival were compared between idiopathic pulmonary fibrosis and non-idiopathic pulmonary fibrosis cohorts. A Cox proportional hazard multivariable regression model was used to adjust for 15 patient characteristics and identify significant predictors of survival.

RESULTS

Of 40,305 lung transplant recipients, 6786 (16.8%) had a primary diagnosis of idiopathic pulmonary fibrosis and were 65 years or older. Idiopathic pulmonary fibrosis patients aged 65 years and older made up 5% of the overall lung transplant population in 2005 and 23% in the first quarter of 2025 (P < .0001). Unadjusted 5-year survival was worse in the idiopathic pulmonary fibrosis patient cohort compared with all other lung transplant recipients (50% vs 59%, P < .0001). Adjusted Cox proportional hazard multivariable regression model identified creatinine, estimated glomerular filtration rate, age, and lung allocation score as predictors of worse survival (P < .05). Creatinine and estimated glomerular filtration rate significantly correlated with the requirement for dialysis before discharge (P < .001), prolonged median postoperative hospital stay (P < .001), and worse 5-year survival (P = .0003).

CONCLUSIONS

The proportion of patients with idiopathic pulmonary fibrosis aged 65 years or older has significantly increased in recent years. Impaired renal function in this population is associated with significantly worse clinical outcomes, warranting special consideration and risk stratification.