How safe is lung transplantation in patients of 65 years or older? A single-center retrospective cohort.

Respir Med Res

APHP.Nord-Université Paris Cité, Hôpital Bichat-Claude Bernard, Service de Chirurgie Vasculaire, Thoracique et Transplantation Pulmonaire, 46 rue Henri Huchard, 75018, Paris, France; Physiopathology and Epidemiology of Respiratory Diseases, UMR1152 INSERM and Université Paris Cité, 16 rue Henri Huchard, 75018, Paris, France.

Published: November 2024

AI Article Synopsis

  • The study examines lung transplantation (LT) outcomes in patients aged 65 and older compared to younger recipients, emphasizing that age shouldn't be a strict barrier for the procedure.
  • Researchers conducted a retrospective analysis of patients who underwent LT at Bichat Hospital, tracking 90-day mortality and other long-term health markers.
  • Results showed that while elderly patients had better short-term lung function post-transplant, their overall survival rates and mortality within the first year were similar to those of younger patients.

Article Abstract

Introduction: With increasing experience in high-volume centers, age alone should not be an absolute contra-indication to lung transplantation (LT) but be considered as part of the patient's initial characteristics. The objective of this study is to provide early and long-term outcomes of LT in recipients aged 65 or older, compared with their younger counterparts.

Methods: This is a retrospective study, including all patients undergoing LT in Bichat Hospital (Paris, France) from January 2014 to March 2019. Two groups were defined depending on the patients' age when they were transplanted: patients older than 65 were defined as the "elderly group" and patients younger than 65 years old were defined as the « younger group ». Primary endpoint was 90-day mortality. Secondary endpoints included 1-year mortality, 1-year FEV1 (forced expiratory volume in one second), and 5-year overall survival.

Results: From September 2014 to March 2019, 22 patients were included in the "elderly group" and 213 were included in the « younger group ». The elderly group had more single LT (SLT) (82% vs. 29%, p < 0.001), with a shorter cold ischemic time (243 min vs. 310 min, p = 0.001) and a lower rate of early humoral rejection (9% vs. 30%, p = 0.045) compared to the younger group. Ninety-day mortality was not significantly different between elderly and younger group (9% vs. 14%, p = 0.95, respectively), nor were 1-year mortality (23% vs. 25%, p = 0.9, respectively) and 5-year overall survival. Six months after LT, FEV1 was significantly better in the elderly group compared to the younger group (77.0% vs. 65.5%, p = 0.037 respectively), but the difference did not reach statistical significance after one year (78.5 vs. 68.3%, p = 0.18 respectively).

Conclusion: Elderly patients underwent more frequently single LT, and achieved similar short and long term postoperative outcomes compared to their younger counterparts. LT for patients 65 years or older should be routinely considered when carefully selected.

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Source
http://dx.doi.org/10.1016/j.resmer.2024.101139DOI Listing

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