Risk factors for mortality in lung transplant recipients aged ≥65 years: A retrospective cohort study of 5,815 patients in the scientific registry of transplant recipients

Mosher, Chris; Weber, Jeremy M.; Frankel, Courtney W.; Neely, Megan L.; Palmer, Scott M.

doi:10.1016/j.healun.2020.10.009

Cited by 28 publications

(19 citation statements)

References 14 publications

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“…[10][11][12][13] Nonetheless, survival is still inferior in these age groups. 14 In the present study, we observed poorer survival in recipients ≥65 years relative to the youngest cohort. It is important to recognize the possible factors that may have influenced the survival of the older patients in this study, including poorer tolerance to immunosuppression, higher risk for cognitive decline, poorer rehabilitation potential, and significant comorbid disease burden.…”

Section: Discussionsupporting

confidence: 44%

“…Several investigations have previously demonstrated acceptable outcomes, including survival and functional status, among carefully selected recipients aged 65 years and older relative to younger cohorts 10–13 . Nonetheless, survival is still inferior in these age groups 14 . In the present study, we observed poorer survival in recipients ≥65 years relative to the youngest cohort.…”

Section: Discussionsupporting

confidence: 41%

“…21,22 We have previously reported our retrospective analysis of the UNOS registry. Recipients, Mosher et al 14 showed that SLT was an independent risk factor for increased mortality. Certainly, these investigations illustrate the propensity for BLT to lead to favorable outcomes after transplant in older patients, as we also demonstrate herein.…”

Section: Discussionmentioning

confidence: 99%

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Outcomes after lung transplantation in recipients aged 70 years or older

Olson

Elnahas

Roy

et al. 2021

Clinical Transplantation

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Background:The proportion of lung transplant (LTx) recipients older than 70 years is increasing, thus we assessed long-term survival after LTx in this cohort relative to younger counterparts. Patients and methods:We retrospectively reviewed charts of patients who underwent LTx between 2012 and 2016 at our center and divided patients by age: group A (<65 years), B (65-69 years), and C (≥70 years). Survival statistics were evaluated using the Kaplan-Meier method and Cox regression. Results:The study included 375 LTx recipients: 221 (58.9%) in group A, 109 (29.1%) in group B, and 45 (12.0%) in group C. Group C was mostly men (37/45 [82.2%]; P = 0.003) and had the highest mean serum creatinine at listing (P = 0.02). Survival at 1, 3, and 5 years after transplant in group A (93.2%, 70.1%, 58.8%) was significantly higher than group B (83.5%, 59.6%, 44.0%; P = 0.005, 0.028, 0.006, log-rank test) and was similar to group C (86.7%, 64.4%, 57.8%), although trended higher at 1 year (P = 0.139, 0.274, 0.489, log-rank test). Groups B and C had comparable survival at all time points. Conclusions:Although survival decreased after age 65, long-term survival was comparable between LTx recipients aged 65-69 years and recipients ≥70 years.

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Section: Discussionsupporting

confidence: 44%

Section: Discussionsupporting

confidence: 41%

Section: Discussionmentioning

confidence: 99%

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Outcomes after lung transplantation in recipients aged 70 years or older

Olson

Elnahas

Roy

et al. 2021

Clinical Transplantation

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“…Importantly, the effect of genotype × age interaction reveals that the age effect comes from the Sparc KO mice rather than WT mice, meaning that it is the Sparc KO in O mice that leads to an increase in the resting lactate compared to both WT mice and KO-Y mice. This also explains, in part, how ageing is both a risk factor for numerous diseases and health conditions [99][100][101][102][103].…”

Section: Body and Tissue Weights (Table 3)mentioning

confidence: 98%

Exercise Training of Secreted Protein Acidic and Rich in Cysteine (Sparc) KO Mice Suggests That Exercise-Induced Muscle Phenotype Changes Are SPARC-Dependent

et al. 2020

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We previously identified secreted protein acidic and rich in cysteine (Sparc) as an exercise-induced gene in young and elderly individuals. Via this animal experiment, we aim to identify selected implications of SPARC mainly within the muscle in the contexts of exercise. Mice were divided into eight groups based on three variables (age, genotype and exercise): Old (O) or young (Y) × Sparc knock-out (KO) or wild-type (WT) × sedentary (Sed) or exercise (Ex). The exercised groups were trained for 12 weeks at the lactate threshold (LT) speed (including 4 weeks of adaptation period) and all mice were sacrificed afterwards. Body and selected tissues were weighed, and lactate levels in different conditions measured. Expression of skeletal muscle (SM) collagen type I alpha 1 chain (COL1A1) and mitochondrially encoded cytochrome c oxidase I (MT-CO1) in addition to SM strength (grip power) were also measured. Ageing increased the body and white adipose tissue (WAT) weights but decreased SM weight percentage (to body weight) and MT-CO1 expression (in WT). Exercise increased SM COL1A1 in WT mice and MT-CO1 expression, as well as weight percentage of the tibialis anterior muscle, and decreased WAT weight (trend). Compared to WT mice, Sparc KO mice had lower body, muscle and WAT weights, with a decrease in SM MT-CO1 and COL1A1 expression with no genotype effect on lactate levels in all our blood lactate measures. Sparc KO effects on body composition, adiposity and metabolic patterns are toward a reduced WAT and body weight, but with a negative metabolic and functional phenotype of SM. Whereas such negative effects on SM are worsened with ageing, they are relatively improved by exercise. Importantly, our data suggest that the exercise-induced changes in the SM phenotype, in terms of increased performance (metabolic, strength and development), including lactate-induced changes, are SPARC-dependent.

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“…This is especially important in the antifibrotic era, where slowing of disease progression may delay the need for LTx in a subset of patients, and in turn lead to encroachment upon programmatic age limits for transplant. A recent study of 5815 patients aged >65 years (70% with restrictive lung disease) demonstrated that increasing age strata, creatinine, bilirubin, hospitalisation at time of transplant, and pre-transplant steroid use were all associated with increased mortality [53]. Other literature focuses on differentiating biological from chronological age, incorporating sarcopenia and frailty, each of which has been independently associated with worse outcomes [54].…”

Section: Advanced Age In Ipfmentioning

confidence: 99%

Lung transplantation for interstitial lung disease

Kapnadak

Raghu

2021

Eur Respir Rev

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Lung transplantation (LTx) can be a life-extending treatment option for patients with advanced and/or progressive fibrotic interstitial lung disease (ILD), especially idiopathic pulmonary fibrosis (IPF), fibrotic hypersensitivity pneumonitis, sarcoidosis and connective tissue disease-associated ILD. IPF is now the most common indication for LTx worldwide. Several unique features in patients with ILD can impact optimal timing of referral or listing for LTx, pre- or post-transplant risks, candidacy and post-transplant management. As the epidemiology of LTx and community practices have evolved, recent literature describes outcomes and approaches in higher-risk candidates. In this review, we discuss the unique and important clinical findings, course, monitoring and management of patients with IPF and other progressive fibrotic ILDs during pre-LTx evaluation and up to the day of transplantation; the need for co-management with clinical experts in ILD and LTx is emphasised. Some post-LTx complications are unique in these patient cohorts, which require prompt detection and appropriate management by experts in multiple disciplines familiar with telomere biology disorders and infectious, haematological, oncological and cardiac complications to enhance the likelihood of improved outcomes and survival of LTx recipients with IPF and other ILDs.

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Risk factors for mortality in lung transplant recipients aged ≥65 years: A retrospective cohort study of 5,815 patients in the scientific registry of transplant recipients

Cited by 28 publications

References 14 publications

Outcomes after lung transplantation in recipients aged 70 years or older

Outcomes after lung transplantation in recipients aged 70 years or older

Exercise Training of Secreted Protein Acidic and Rich in Cysteine (Sparc) KO Mice Suggests That Exercise-Induced Muscle Phenotype Changes Are SPARC-Dependent

Lung transplantation for interstitial lung disease

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