Functional Status After Lung Transplantation in Older Adults in the Post-Allocation Score Era

Abstract

This manuscript describes the functional status trajectory of older (age 65 or older) and younger (age 18–64) adults after Lung Transplantation (LT). After the implementation of the Lung Allocation Score (LAS) in 2005, older adults became the fastest growing subgroup of recipients. Yet the impact of LT on physical function, a main determinant of quality of life in older adults, is unknown. We conducted a retrospective cohort study using United Network for Organ Sharing data on 4805 adults who received a LT during 2005–2009. We divided them into older (≥65, n=774) and younger (18–64, n=4031) cohorts. Functional status was measured by Karnofsky Performance Score (KPS). Mixed models estimated the impact of age group on the rate of functional decline starting at one-year post-transplantation. We controlled for KPS at transplantation, gender, race, diagnosis, LAS and LT type. Age group was not associated with different rates of decline in KPS over time. On average, recipients who were older, received a single LT, or had a low KPS at transplantation had worse functional status post-transplantation when compared to their counterparts, but rarely reached disability at 48-months. Overall, LT had a positive and durable effect on physical function for both older and younger recipients.

Lung transplantation in elderly patients

“…Finally, in a large cohort study of US transplants from 2005-2009, there was no difference in rate of functional decline, as measured by Karnofsky performance score, in recipients 65-69 and those >70 compared to younger recipients. Recipients older than 70, however, had worse overall post-transplant functional status than those 65-69, who, in turn, had worse functional status than those <65 (13,24).…”

Functional status, healthcare utilization, and the costs of liver transplantation

“…Functional status was measured using the KPS score, a clinician‐rated measure initially developed for oncology patients, which has been validated across multiple healthcare settings . The score estimates the ability to perform activities of daily living and is measured from 0 to 100% according to the following criteria: no assistance needed as KPS 80%‐100%, minimal assistance as KPS 50%‐70%, and full assistance as KPS 10%‐40%, with death categorized as KPS 0%. Thus, if patients needed any assistance at all for activities of daily living, their KPS score could be no more than 70%.…”

Is There an Age Limit to Lung Transplantation?

“…This study reports survival data with no mention of morbidity or quality of life. Quality of life is a major consideration after lung transplantation [23]. Investigation into quality of life and morbidity is warranted before lung transplantation can be recommended for older patients.…”