Lung Transplantation Safe, Effective in Older Patients

A new study has found that lung transplantation may be safely undertaken with acceptable clinical outcomes in patients over 65 years of age.

Researchers at the University of California Los Angeles (UCLA, USA) school of medicine reviewed the records of lung transplant recipients from March 2000 to September 2006, and compared the outcomes in 50 patients aged 65 years and older with a another group of 50 patients younger than 65 years that were matched to the older cohort by means of propensity analysis. The median waiting time for both groups was less than three months throughout the observation period, and decreased to 47 days after a new allocation system was implemented in May 2005. Older patients were likelier to receive single-lung transplants (76%) than were younger patients (16%), with the minority of older patients receiving double-lung transplantation for severe pulmonary hypertension or infectious lung diseases.

The researchers found that there were no intraoperative deaths and no notable differences in median duration of mechanical ventilation, intensive care unit stay, hospital stay, oxygenation parameters, or in-hospital morbidity between the groups. The occurrence of bronchiolitis obliterans syndrome (BOS) in the first post-transplantation year was about twice as high in older recipients as was in younger patients; however, the prevalence of BOS plateaued in older patients but continued to increase in younger patients. There was no statistically significant difference in the prevalence of BOS overall between patients older versus younger than 65. There was no significant difference in the in-hospital, 1-year, or 3-year survival between the groups, though there were more deaths during the 1-month to 1-year interval in the older group because of infections, probably due to immunosenescence of the older patients. The study was published in the February 2008 issue of The Journal of Thoracic and Cardiovascular Surgery.

"Lung transplantation can be performed safely and with comparable short-term and medium-term survival in selected patients older than 65 years,” concluded lead author Raja Mahidhara, M.D., and colleagues of the division of cardiothoracic surgery. "However, multidisciplinary consensus is needed to determine the ethical standards in offering lung transplantation to the elderly given the critically short supply of donor organs.”

Current consensus guidelines recommend an upper age limit of 65 years for single-lung transplantation and 60 years for double-lung transplantation.


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