Successful bilateral lung transplant outcomes in recipients 61 years of age and older.
BACKGROUND
Controversy exists regarding the optimal use of bilateral lung transplant (BLT) in older recipients in diseases where either single or bilateral transplant is appropriate. International Society for Heart and Lung Transplant (ISHLT) guidelines suggest an upper age limit of 60 for BLT, despite limited data regarding outcomes with BLT in patients over 60. We hypothesize that BLT offers comparable, if not superior, clinical outcomes to SLT in all patients independent of recipient age.


METHODS
In order to test our hypothesis, we conducted a case-control study to compare the effect of transplant operation on survival and the onset of bronchiolitis obliterans syndrome (BOS) in consecutive lung transplant recipients 61 years of age or older using Kaplan- Meier analysis and Cox proportional hazard models.


RESULTS
We identified 107 consecutive lung transplant recipients 61 or older at the time of transplant. Patients received SLT (n=46) or BLT (n=61) based on donor organ availability. Comparable survival was achieved with BLT in older patients vs. SLT P=0.19). One-, two-, and five-year survival estimates in BLT were 82%, 75% and 68%, respectively, vs. in SLT 78%, 70% and 44%, respectively. A comparable onset of BOS was also observed in the patients who received BLT vs. SLT (P=0.23).


CONCLUSIONS
Successful short- and medium-term outcomes are achieved with BLT in older recipients and are comparable to those achieved with SLT. Our results suggest that age over 60 should not exclude patients from consideration of BLT.
Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA. palme002@mc.duke.edu
Scott M
SM
Palmer
R Duane
RD
Davis
Sinan A
SA
Simsir
Shu S
SS
Lin
Matthew
M
Hartwig
Mike F
MF
Reidy
Mark P
MP
Steele
P C
PC
Eu
James A
JA
Blumenthal
Michael A
MA
Babyak
D000367:Age Factors; D000368:Aged; D001989:Bronchiolitis Obliterans / Q000209:etiology; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D016040:Lung Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged