Lung transplantation a viable option in patients under 70
Mar 10, 2009 - 10:55:29 PM
New research published in the March issue of the Journal of the American College of Surgeons suggests that lung transplantation should be used with caution in patients older than 60 years and that the procedure is associated with high rates of mortality after one year in patients 70 and older.
Lung transplantation has been the gold-standard treatment for a variety of end-stage lung diseases, but candidate selection varies greatly among transplantation centers. The International Society for Heart and Lung Transplantation (ISHLT) reports that since 1985 the percentage of older patients receiving lung transplantation has increased steadily, with 24 percent of recipients in 2006 being older than age 60. This trend has raised concerns among transplant centers, since there is no consensus on potential age limits for the operation.
"These data underscore the importance of carefully considering age among potential lung transplantation recipients," said Eric S. Weiss, MD, division of cardiac surgery, The John Hopkins Hospital, Baltimore, MD. "Although age is only one of many important criteria, advanced age appears to have a major impact on post-surgical mortality. Our findings suggest that lung transplantation remains a viable option for appropriate candidates younger than age 70."
This new research study in JACS expands on previous findings reported by Dr. Weiss and colleagues. In October 2007 (93rd annual Clinical Congress Congress of the American College of Surgeons), Dr. Weiss reported that lung transplants improved survival rates in patients over 60 years of age. In this previous study the Johns Hopkins researchers looked at factors that create positive results in a 60-plus patient population, which has typically been regarded as not being the best candidates for lung transplantation. Upon analyzing patient outcomes, the researchers found that the survival rates between older and young patients were not all that different, especially at the 30-day survival period, and they concluded that this elderly patient population should not be categorically excluded from being offered the procedure as a treatment option. In the study just released in JACS, the researchers are able to make more specific recommendations for patients in the 60 to 70-years of age range, and beyond.
This new retrospective study examined 8,363 adult patients who underwent lung transplantation between 1999 and 2006. The United Network for Organ Sharing (UNOS) database provided the data, which was stratified into four quartiles (Q) of age: Q1, 18 to 45 years; Q2, 46 to 55 years; Q3, 56 to 60 years; Q4, 61 to 79 years. Patients in Q4 were further examined in smaller increments of age to assess differences in outcomes among the oldest groups of transplant recipients.
Patients in all four age quartiles had similar 30-day and 90-day mortality rates, but patients in Q4 experienced the highest mortality rates at 1-year post-transplant (21.4 percent, p=0.002). Of the 57 patients identified as 70 or older, 34 percent of the patients died during the study period. Additionally, both the 90-day and the 1-year mortality rates of the 70 years or older cohort was significantly higher than those patients under 70 (27 percent versus 9 percent for 90 day; and 42 percent versus 18 percent for 1 year; p< 0.001 for both comparisons).
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