Elderly lung transplant patients more likely to survive
Newswise — Who is too old to receive a lung transplant?
“There is no clear answer at this time. Nor was there a clear answer
when the guidelines for lung transplantation were written in 1998.
They were based on the best clinical data then available,” explained
Dr. Philip W. Smith, a surgery resident and research fellow at the
University of Virginia Health System.
Since lung transplantation (LTX) was first performed in 1983, it has
been a viable therapy for patients with progressive end-stage lung
disease. However, transplant centers have found it necessary to
adhere to patient age restrictions for LTX because supplies of donor
organs are scarce and mortality risks for the elderly are high.
While they have risen in recent years, the recommended age limits
for LTX are now 60 for bilateral lung transplantation (BLT) and 65
for single-lung transplantation (SLT). These guidelines are based on
the experience of academic institutions such as UVa, which is among
several centers now exploring if further revisions are reasonable.
According to Smith, age restrictions are a pressing issue for the
medical community because the number of people age 60 and older is
growing rapidly, and this group will soon constitute a quarter of
the U.S. population.
Smith said that he and Dr. David R. Jones, surgical director of
UVa’s Lung Transplant Program, were concerned about categorically
excluding the elderly from receiving LTX. “This concern prompted the
retrospective study we recently completed,” Smith said.
Published last month in The Annals of Thoracic Surgery, the
study reviewed the outcomes of 182 LTX recipients treated at UVa
between 1995 and 2005. Of those patients, 52 (or 29 percent) were
between 60 and 69 years old. Sixteen patients (or 9 percent) were
aged 65 or older.
“Age is not an independent exclusion criterion at our center,“ noted
Jones. “All patients undergo the same pre-transplant evaluation to
determine their eligibility. Our study shows that lung
transplantation can be performed with acceptable outcomes in
patients aged 60 and older, if the person is otherwise an
With the exception of recipient-age recommendations, UVA follows the
International Guidelines for the Selection of Transplant Candidates
in choosing LTX recipients.
Study findings showed that lung transplant recipients age 60 and
older have a major survival advantage at UVa compared to patient
data compiled by the United Network for Organ Sharing (UNOS), a
national registry that tracks outcomes at U.S. transplantation
centers. Five-year survival rates of patients in this age group were
54.7 percent at UVa and 38.6 percent in the UNOS database.
Researchers found that survival rates for UVa’s younger LTX patients
also exceeded those reported by UNOS. The five-year survival rate
for LTX patients under 60 was 61.0 percent at UVa and 49.8 percent
among UNOS registrants.
The researchers attributed UVa’s results to several factors. “Our
findings show that the quality of care provided during the very
early period following a lung transplant is key to long-term success
for elderly recipients. We’ve established a multidisciplinary team
to ensure that optimal care is provided during this crucial time,”
Another factor, noted Smith, is that UVa “almost exclusively
performs SLT rather than BLT for recipients aged 60 and older – and
we do so at a significantly higher rate than other transplant
centers. We believe that this is the most appropriate procedure for
the vast majority of these patients.”
During the study’s timeframe, only one elderly patient at UVa
received BLT rather than SLT.
“The issue of which procedure yields the best outcomes for older
patients remains unresolved,” Smith said. “Some centers are
performing more BLT on older patients and believe that to be the
appropriate approach. At some point, the collective experience,
including this study, will be reviewed and the guidelines will be
adjusted accordingly. “