Wednesday, April 29, 2009

Lung transplant contraindicated for patients 70 years or older

Transplant Living News

NEW YORK (Reuters Health) - A retrospective review of United Network for Organ Sharing (UNOS) data has led reviewers to conclude that lung transplantation may be used "with caution" in patients older than age 60 but "should not be used for patients older than age 70."

"From current guidelines, there exists no definitive recommendation regarding the maximum age that is safe for lung transplantation," Dr. Eric S. Weiss from The Johns Hopkins Hospital, Baltimore, Maryland, who led the effort, told Reuters Health.

He and colleagues analyzed the impact of advanced age on short- and intermediate-term outcomes for 8,363 adults who had a lung transplant between 1999 and 2006. Patients were stratified by age into four quartiles: (Q1) 18 to 45 years (n=2192); (Q2) 46 to 55 (n=2160); (Q3) 56 to 60 years (2000); and (Q4) 61 years to 79 years (2011).

"The findings of this study show that patients age 60 to 69 can be transplanted safely with acceptable short and long term results," Dr. Weiss told Reuters Health.

Patients in all four age quartiles had similar 30-day and 90-day mortality rates, the investigators found. Thirty-day mortality rates for Q1, Q2, Q3, and Q4 were 5.5%, 5.3%, 5.4% and 4.6%, respectively, while 90-day morality rates were 9.5%, 9.5%, 8.9% and 9.3%, respectively.

"Importantly," Dr. Weiss said, "although I think some clinicians are reticent to transplant older patients due to fear of operative and short-term mortality, our study shows that short term survival is no different in older patients relative to young patients."

At 1-year, patients in Q4 (age 61-79) had mortality rates of 21.4%. One-year mortality rates for the other groups were 17.3%, 17.2% and 18.7% in Q1, Q2 and Q3, respectively.

According to Dr. Weiss, patients age 70 and older had "exceedingly high mortality rates." Of the 57 patients identified as 70 or older, 34% of the patients died during the study period. These patients had a 30-day mortality rate of 7% and 1-year mortality rate of 42%.

"We did not expect to see such a strikingly high mortality rate for the 57 patients age 70 and older in this study," Dr. Weiss admitted. "I think the findings of this study support transplantation for patients younger than age 70 only," he concluded.

J Am Coll Surg 2009;208:400-409.

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