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Study finds good outcomes for Older Lung
Transplant patients
Newswise — In the world of organ donation,
it has been common practice to exclude older
patients from receiving transplants because
of limited donor supply and lower survival
rates.
However, patients such as Lois Tumanello,
who received a successful lung transplant at
65, are proving that perhaps age does not
always matter.
A new UCLA Medical Center study shows that
select patients age 65 and older can safely
undergo lung transplantation and have
acceptable outcomes. The findings are
reported in the February issue of the
peer-reviewed Journal of Thoracic and
Cardiovascular Surgery.
Since 1999, UCLA has been one of the few
transplant centers in the country to offer
lung transplants to patients 65 and older
who were otherwise healthy candidates for
the procedure.
"Over the past decade, various reports have
shown that older recipients undergoing all
types of solid-organ transplantation can
have good outcomes," said study co-author
Dr. Abbas Ardehali, associate professor of
cardiothoracic surgery and director of the
UCLA Lung Transplant Program.
"We wanted to
define the short- and medium-term outcomes
of lung transplantation in these older
patients to determine whether the outcomes
were acceptable."
The study reviewed records of UCLA patients
who received lung transplants between March
2000 and September 2006.
During this period, 50 transplant surgeries
were performed on 48 patients between the
ages of 65 and 72. A group of 50 patients
younger than 65 were matched to the older
cohort for comparison purposes.
Survival rates for both groups were similar.
The early survival rate of the older
patients was 95.7 percent, compared with
95.9 percent for the younger cohort.
The one-year survival rate was 79.7 percent
for the older group and 91.2 percent for the
younger, and the three-year survival rate
was 73.6 for the older group and 74.2
percent for the younger.
Researchers found that older patients were
more likely to receive single-lung
transplants (76 percent, compared with 16
percent for the younger group) and to
receive nonstandard lungs (46 percent,
compared with 28 percent). Nonstandard lungs
are those considered "less than perfect" but
still acceptable for transplantation.
The study's findings suggest that the
increased mortality rate among older
patients during the period from one month to
one year following transplantation — due
predominantly to infection — may result from
immunosenescence, the gradual deterioration
of the immune system with age.
"This finding warrants adjustments in the
immunosuppresion protocols for older
patients," said lead author Dr. Raja
Mahidhara, UCLA assistant professor of
cardiothoracic surgery. "In addition, future
studies should look at the effects of lung
transplantation in older recipients on the
donor pool and on other, younger patients on
the waiting list."
Tumanello, now 66, suffered from emphysema
for more than nine years before receiving a
single-lung transplant at UCLA in March
2007. Since then, she said, she has felt
wonderful and has been enjoying the freedom
to go anywhere and do anything she wants.
Married, with three grown children and five
grandchildren, Tumanello says she is
grateful every day for the generous gift she
received and is committed to taking care of
her new lung.
"I think everyone should be given a chance,"
she said.
In addition to Ardehali and Mahidhara, UCLA
researchers included Dr. Sam Bastani, Dr.
David J. Ross, Dr. Rajan Saggar, Dr. Joseph
Lynch III, Dr. Gabriel T. Schnickel, David
Gjertson and Dr. Ramin Beygui.
Lung transplantation has emerged as an
effective treatment for end-stage lung
disease. Since the inception of UCLA's
program in 1988, more than 400 patients have
undergone lung transplantation at UCLA.
Recent advances in preservation methods,
surgical techniques and immunosuppressive
drugs have steadily improved the results of
lung transplantation. Moreover, improvements
in post-transplant care have significantly
bettered the quality of life for lung
transplant recipients.
For more information, visit
http://www2.healthcare.ucla.edu/transplant/lung.html
.
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