*Purpose: Lung transplant programs are typically assessed based on 1-/3-year survival, however other factors such as quality of life, freedom from rejection and oxygen, etc., are important factors to recipients and the health care system. Thus, we defined a “textbook outcome” (TO) for lung transplant recipients as one without major complication as an ideal post-transplant course, and examined the association with long-term survival.

*Methods: All primary, adult lung transplants from 5/1/05-12/31/17 were identified with the SRTR dataset. TO was defined as absence of mortality, retransplant, graft failure, dialysis, treated rejection in the 1^st year, length of stay <31 days, and no airway dehiscence, post-transplant stroke, or use of oxygen at 1-year, and forced ejection volume at 1 second (FEV1) greater than the 50% predicted at 1 year. Recipient and transplant characteristics were analyzed. Kaplan-Meier analysis with the log-rank test examined long term survival for patients surviving >1 year (conditional survival).

*Results: 14,842 patients were identified and 7,319 (49.3%) had a TO. Patients not achieving a TO typically failed to satisfy 2 or more criteria. Characteristics that were significantly associated with TO included white race, not being hospitalized prior to transplant, decreased median ischemic time, or diagnosis of obstructive disease or cystic fibrosis (p<0.01; Table). At 1 year the FEV1 was greater in patients who achieved a TO (81% Predicted) as compared to those who did not (64% Predicted). Conditional survival analysis revealed significantly increased survival at 5 years in patients who achieve TO (p<0.01; Figure).

*Conclusions: Textbook outcome is a novel means of examining patient outcomes in lung transplantation and adds further meaning to short term survival, the current standard of success. Given the association of TO with increased long-term survival and an improved FEV1 at 1-year, patients achieving a TO appear to have an increased quantity and potentially quality of life. Further examination and validation of this metric is warranted.

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