Introduction In recent years there has been a large increase in rates of lung transplantation for IPF patients. This has driven by the introduction of the Lung Allocation Score in the US, which prioritises patients based on treatment need and benefit. Increasing rates of transplantation have led to older patients being considered for transplant listing. The aim of this study was to assess the survival, functional capacity and quality of life of IPF patients aged over 70 attending our transplant programme.
Methods Post-transplant IPF patients aged 70 years or older were identified from the National Lung Transplant Registry. Health-related Quality of Life (HRQL) was assessed using the 36-item Medical Outcomes Survey Short Form (SF-36). Functional status was assessed by exercise tolerance, pulmonary function and level of respiratory support. HRQL was compared to published datasets from randomised clinical trials of drug therapy as well as prospective studies in lung transplant recipients.
Results 6 patients met the inclusion criteria, mean age 72.5 ± 0.8 yrs. The mean time from transplant was 3.8 ± 1.5 yrs (range 2.3 – 7.0 yrs). Compared to the BUILD-1 trial (similar age, limited IPF), minimal important clinical differences (MID)1 were seen across many components of the SF-36 score. These MIDs included physical functioning (+7.1), health perception (+29.2) and vitality (+17). Compared to a post-transplant cohort of younger IPF patients (61.0 ± 1.5 yrs)2 the mental component score (MCS) was higher in this study (+12.2). These benefits in MCS were maintained when compared to patients in the IFIGENIA study of N-acetylcysteine and the STEP-IPF study of sildenafil. The mean reported exercise tolerance of our patient group was 1.2 km, and no patient required supplementary oxygen or respiratory support. Compared to pre-transplant status large benefits in function were noted (mean pre-transplant 6MWT was 314 ± 91 m with 6 L oxygen/minute).
Conclusion Lung transplantation provides clinically meaningful benefits in HRQL and functional outcomes in patient’s ≥ 70 yrs old. This study highlights that these benefits are comparable to younger IPF patients who receive lung transplant and more beneficial to those reported in drug trials.
References 1 Respir Med. 2010;104(2):296–304
2 J Heart Lung Transplant. 2014;33(5):514–520