Key predictors of long-term survival after lung transplantation in Japan

Background: Lung transplantation (LTx) is essential for treating end-stage lung diseases in Japan, achieving favorable long-term survival despite donor shortages. However, factors associated with long-term survival after transplantation remain unclear. This study aims to identify key predictors influencing post-transplant outcomes. Methods: A retrospective analysis was conducted on LTx recipients at Tohoku University Hospital from 2000 to 2019, with a follow-up period of five years to 2024. Recipients were categorized into short survivors (<5 years) and long survivors (≥5 years). The analysis focused on recipient demographics, donor characteristics, surgical factors, and post-transplant outcomes. Results: Of 124 recipients, 36 were short survivors, and 88 were long survivors. Long-term survivors were younger, with a lower prevalence of patients aged 55 years and older. Additionally, fewer long-term survivors received lungs from critically marginal donors compared to short-term survivors. CMV serology was a significant factor, with a higher incidence of CMV disease observed in short-term survivors. Conclusion: The study identified younger age, selective donor use, and CMV status as key predictors associated with long-term survival after LTx in Japan. The findings underscore the importance of targeted CMV management strategies and suggest that future multicenter studies with larger, more diverse populations are needed to confirm these results and further enhance long-term survival outcomes.