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Abstract
Rationale Lung transplantation has become an accepted treatment option in a select group of patients with end-stage lung disease. The current International Society for Heart and Lung Transplantation (ISHLT) guidelines suggest age above 65 is a relative contraindication. However, increasingly patients with COPD and IPF are being referred for consideration after this age. The outcomes in this group (above 65) are not well described. We have studied the characteristics and outcomes of patients aged 65 and over, offered lung transplantation in our institution.
Method Retrospective review from the transplant database and patient records. We examined the Age, Sex, Indication for transplant and cause of death in all transplant recipients aged 65 and over from 1991 to July 2013. As a control group we compared them with 50 single lung transplant recipients front the same era and institution who were under 65. We used SPSS to generate the survival curves.
Results In total we had 19 lung transplant recipients aged 65 and over who all had a single lung transplant, with a mean survival of 1600 days post-transplant. 13/19 were male recipients. The indication for transplantation was COPD and IPF in all. The cause of death was BOS in 9/14, malignancy in 2/14 and pulmonary embolism, stroke and bleeding in the others. When compared with 50 single lung transplant recipients aged 60–64, we did not find any statistically significant differences in survival (p value 0.158) (see figure 1), cause of death and reason for transplantation.
Conclusion We have shown from our limited data that patients aged 65 and over have very similar outcomes to their younger counterparts. Hence, age whilst still important should not be a deterring factor when referring patients for lung transplant assessment. It would also be important to examine longer term outcomes and complications such as rates of renal dysfunction, hypertension, rejection and admissions into hospital. As the number of patients aged 65 and older receiving lung transplant increases, we should be able to gather more effective data.
Survival Functions