Lung Transplantation in Patients 60 Years and Older: Results, Complications, and Outcomes

Smith, Philip W.; Wang, Hongkun; Parini, Vamsi; Zolak, Jason S.; Shen, K. Robert; Daniel, Thomas M.; Robbins, Mark D.; Tribble, Curtis G.; Krön, Irving L.; Jones, David R.

doi:10.1016/j.athoracsur.2006.05.036

Cited by 31 publications

(19 citation statements)

References 12 publications

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“…Several single-institution case series reports have indicated that lung transplantation in patients between the ages of 50 and 60 is associated with increased mortality [7][8][9]15]. Others have demonstrated acceptable clinical outcomes in patients 65 and older [4,5,11]. The available single-institution studies in most cases present a bias toward offering SLT rather than BLT for older recipients [5,6,9,11,14].…”

Section: Commentmentioning

confidence: 91%

“…Others have demonstrated acceptable clinical outcomes in patients 65 and older [4,5,11]. The available single-institution studies in most cases present a bias toward offering SLT rather than BLT for older recipients [5,6,9,11,14]. This has been a common sentiment even in the modern era, as demonstrated by a survey of North American centers in which more than 70% of transplant centers considered age older than 65 an absolute contraindication to BLT [16].…”

Section: Commentmentioning

confidence: 91%

“…The general tendency has been to opt for SLT in older recipients because it is believed to be a lower-risk procedure [7,8,[11][12][13][14]; however, the justification is still not unanimous, and further objective evidence is needed.…”

mentioning

confidence: 98%

“…Reported 5-year survival rates in patients 65 or older have been significantly lower [2,[7][8][9]. Several studies have examined this older group of lung transplant recipients in the broader perspective [4,7,8,10,11], but we aimed to more closely examine the short-term and long-term transplant outcomes across the age range of 65 to 79 years compared with the standard recipient age group of 12 to 64 years.…”

mentioning

confidence: 98%

See 3 more Smart Citations

Is There an Age Limit to Lung Transplantation?

Roy

Alarcón

Walia

et al. 2015

The Annals of Thoracic Surgery

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Section: Commentmentioning

confidence: 91%

Section: Commentmentioning

confidence: 91%

mentioning

confidence: 98%

mentioning

confidence: 98%

See 2 more Smart Citations

Is There an Age Limit to Lung Transplantation?

Roy

Alarcón

Walia

et al. 2015

The Annals of Thoracic Surgery

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“…Inzwischen werden auch zunehmend Patienten > 60 Jahre transplantiert. In einer Studie aus dem Jahr 2006 [28] wurde diese Patientengruppe > 60 Jahre untersucht. Hauptindikation für die Lungentransplantation war in drei Viertel der Fälle die COPD.…”

Section: Lungentransplantationunclassified

Clinical Year in Review – fortgeschrittene COPD („chronic obstructive lung disease“)

Köhler

2007

Med Klin

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COPD is a frequent disease, affecting approximately one in four smokers. In older patients > 70 years of age, the proportion of individuals who never have smoked increases up to one in three individuals. Severe disease is present in 10%, and the limitation of performance is usually caused by airway obstruction, in a smaller portion of patients by the loss of alveolar surface (emphysema). After medical treatment with antiobstructive and anti-inflammatory drugs, oxygen remains a major therapy option. With it, hypercapnic patients benefit most from long-term therapy. Patients with predominant emphysema benefit most from high-flow (6-8 l/min) oxygen therapy during exercise. Permanent yellow or greenish sputum decoloration is suggestive of chronic bacterial colonization. This group of patients may benefit from a permanent inhalative therapy with antibiotics (mainly aminoglycosides). There is growing evidence from current literature to support this concept. If dyspnea is severe, especially during mild exercise, a subset of patients might benefit from the use of long-acting morphium. Goal of this therapy is to downregulate breathing control. Predominantly "pink puffers" seem to respond. A dose of 10-20 mg will usually be sufficient. Life-threatening hypercapnia is usually not observed with this form of therapy. Noninvasive ventilation is an option for patients with severe hypercapnia. Thereby, ventilatory pressure or inspiratory volume should be selected to effectively unload the respiratory muscles. This will increase quality of life. Life span is likely to be prolonged, however, comparative data where patients were effectively ventilated (as seen on the reduction of hypercapnia) are missing. A multicenter trial addressing this topic is currently being conducted in Germany. Independent of the severity of COPD, patients in general benefit from physical training with alternation of endurance and interval training being most effective. This will decrease the number of hospital admissions and probably mortality as well. Lung volume reduction surgery virtually treats lung hyperinflation. Bullectomy is still considered effective for isolated bullous emphysema as well as lobectomy, if this portion of the lung is without function. Shaving procedures are still associated with high rates of complications and should only be performed in selected cases. Effectiveness of endoscopic lung volume reduction surgery by implantation of plugs or valves cannot be assessed yet. First data are rather disappointing. Ultimate alternative remains lung transplantation with life expectancy ranging between 5-6 years independent of age. Indeed, consequent application of previously described measures might preserve a stable state over many years.

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Patient Selection and Indications for Lung Transplantation

Garrity

2014

Textbook of Organ Transplantation

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Lung Transplantation in Patients 60 Years and Older: Results, Complications, and Outcomes

Cited by 31 publications

References 12 publications

Is There an Age Limit to Lung Transplantation?

Is There an Age Limit to Lung Transplantation?

Clinical Year in Review – fortgeschrittene COPD („chronic obstructive lung disease“)

Patient Selection and Indications for Lung Transplantation

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