According to a large case-control study, investigators report that factors that appear to favor long-term survival in lung-transplant recipients include bilateral vs single grafts, close human leukocyte antigen (HLA) matching, and higher level of recipient education. In a study of that involved 5100 lung transplant patients, Eric Weiss, MD, a postdoctoral research fellow from the Division of Cardiac Surgery at Johns Hopkins University School of Medicine, in Baltimore, Maryland said that 17% of whom lived for at least 10 years after a first transplant, those who received a bilateral graft had about a 2.5-fold better chance for survival than patients who received only 1 lung. He said that the factors that predict long-term survival are not well understood and the factors that might differentiate long-term from intermediate survivors are poorly understood. The authors conducted a nested case-control study using prospectively collected United Network for Organ Sharing (UNOS) data on lung-transplant recipients to know whether they could tease out predictive factors. The authors created multivariate models that incorporated preoperative, operative, and patient-specific factors (including age, primary diagnosis, level of education, bilateral vs single graft, body mass index, oxygen requirements, hypertension, race mismatch, and HLA match greater than 2), and postoperative factors (including bronchiolitis obliterans syndrome, new-onset dialysis requirements, and hospitalizations for rejection and infection). They found that significant predictors of survival included patient age at transplantation, with patients aged 18 to 35 years having a slight edge over older patients (odds ratio [OR], 1.07; 95% confidence interval [CI], 1.01 - 1.3; P = .04), bilateral vs single lung transplant (OR, 2.01; 95% CI,1.24 - 43.36; P = .005), college education (OR, 1.49; 95% CI,1.03 - 2.15; P = .03), and the number of hospitalizations for infection (OR, 1.27; 95% CI,1.09 - 1.48; P = .002). In contrast, there was an inverse relation with hospitalization for rejection, which was associated with a chance for survival about one-third lower (OR, 0.65; 95% CI, 0.51 - 0.82; P < .001). Receiving a transplant at a high-volume center was also associated with a significantly greater chance for decade-long survival, although this effect was small (OR, 1.02; 95% CI, 1.01 - 1.04; P = .04). Dr. Weiss said, other factors that appeared to confer a survival advantage were white race and cystic fibrosis as the primary indication for lung transplantation. He did not show the data supporting these assertions, nor did he show or discuss the odds ratios associated with better HLA matching.