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J Thorac Cardiovasc Surg 2008;135:412-420
© 2008 The American Association for Thoracic Surgery

Cardiothoracic Transplantation

Lung transplantation in older patients?

^a Division of Cardiothoracic Surgery, Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, Calif
^b Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, Calif
^c Department of Pathology and Laboratory Medicine–Immunogenetics Center, David Geffen School of Medicine at University of California, Los Angeles, Calif

Received for publication May 4, 2007; revisions received August 9, 2007; accepted for publication September 11, 2007.

^_* Address for reprints: Abbas Ardehali, MD, Division of Cardiothoracic Surgery, CHS 62-186, UCLA Medical Center, 10833 Le Conte Ave, Los Angeles, CA 90095. (Email: aardehali{at}mednet.ucla.edu).

Objective: Age 65 years and older is generally considered a contraindication to lung transplantation. Our group has offered lung transplantation to select patients 65 years of age and older who lack other comorbid conditions. We sought to define the short- and medium-term outcome of lung transplantation in patients aged 65 years and older.

Methods: We reviewed the records of our lung transplant recipients from March 2000 to September 2006. During this interval, 50 patients were 65 years or older at the time of transplantation. Fifty patients younger than 65 years were matched to the older cohort by means of propensity analysis. The demographics and perioperative and postoperative characteristics and survival of the 2 groups were compared.

Results: Older patients were more likely to receive single-lung transplantation (older group: 76% vs younger group: 16%, P < .05) and nonstandard donor lungs (older group: 46% vs younger group: 28%, P = .06). The composite in-hospital morbidity rate was similar in the older and younger groups. There was no significant difference in the early oxygenation parameters, incidence of acute cellular rejection, or incidence of bronchiolitis obliterans syndrome between the 2 groups. The early survival of the older patients was 95.7% compared with 95.9% in the younger cohort (P = .73). The 1-year survival of the 2 groups was also similar (older group: 79.7% vs younger group: 91.2%, P = .16). The 3-year survival of the older and younger recipients was 73.6% and 74.2%, respectively (P = .64). There were 8 deaths in the older recipient group during the 1-month to 1-year posttransplantation interval, predominantly because of infections.

Conclusions: Lung transplantation can be performed in patients older than 65 years with acceptable clinical outcomes. The "increased" mortality of older patients between 1 month and 1 year after transplantation, predominantly from infectious causes, might be due to immunosenescence of older patients. This finding warrants adjustments in the immunosuppression protocol of older patients undergoing lung transplantation. The effect of offering lung transplantation to older patients on donor lung availability deserves further investigation.

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