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Abstract
Introduction and Objectives Idiopathic pulmonary fibrosis (IPF) is a chronic, fibrosing interstitial pneumonia of unknown aetiology. Its clinical course is unpredictable but invariably leads to progressive respiratory failure and death. Median survival from time of diagnosis, without transplant, is 2–3 years.
IPF patients referred for transplantation often suffer from poor outcomes, due to organ shortage and rapid disease progression. In America, the introduction of the lung allocation score has greatly benefited the IPF cohort. Furthermore, an increasing proportion of these transplants have occurred in patients over the age of 65 - an age group that had previously been associated with high post-transplant mortality. Recent data has however contradicted this, showing that surgical outcomes and survival are satisfactory in this age group.
In a condition with no disease modifying medical therapy, we reviewed the survival benefit of lung transplantation in age-stratified groups to see if our data matched those seen internationally and to encourage further transplantation in this older population.
Methods All patients with IPF who received lung transplantation in Ireland, since the beginning of the transplant service in 2005, were included (n = 30). Data collected included patient demographics, lung function, transplant details and survival data. Survival data was compared with IPF patients who had died while awaiting a transplant over the past 3 years (n = 20).
Results For those patients on the lung transplant waiting list, who did not receive a transplant, survival was unfortunately poor (75% at 6 months, 30% at 12 months, and 15% at 18 months). However, following transplantation, all-age survival was 96.6% at 1 year, 90.1% at 2 years and 78.9% at 5 years. The 5 year survival for those transplanted over the age of 65 was 88.9% (n = 9).
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Conclusion As patients who suffer from IPF commonly present in their 7th decade, the consideration of patient age is pertinent when referring for transplantation. Although, many centres view age greater than 65 as a relative contraindication to lung transplantation, we feel that this data reinforces the alternative viewpoint - that age should not be a limiting factor, in carefully selected candidates.