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Journal of American College of Surgeons finds lung transplantation should be used in older patients
March 10, 2009New research published in the March issue of the Journal of the American College of Surgeons suggests that lung transplantation should be used with caution in patients older than 60 years and that the procedure is associated with high rates of mortality after one year in patients 70 and older.
Lung transplantation has been the gold-standard treatment for a variety of end-stage lung diseases, but candidate selection varies greatly among transplantation centers. The International Society for Heart and Lung Transplantation (ISHLT) reports that since 1985 the percentage of older patients receiving lung transplantation has increased steadily, with 24 percent of recipients in 2006 being older than age 60. This trend has raised concerns among transplant centers, since there is no consensus on potential age limits for the operation.
"These data underscore the importance of carefully considering age among potential lung transplantation recipients," said Eric S. Weiss, MD, division of cardiac surgery, The John Hopkins Hospital, Baltimore, MD. "Although age is only one of many important criteria, advanced age appears to have a major impact on post-surgical mortality. Our findings suggest that lung transplantation remains a viable option for appropriate candidates younger than age 70."
This new research study in JACS expands on previous findings reported by Dr. Weiss and colleagues. In October 2007 (93rd annual Clinical Congress Congress of the American College of Surgeons), Dr. Weiss reported that lung transplants improved survival rates in patients over 60 years of age. In this previous study the Johns Hopkins researchers looked at factors that create positive results in a 60-plus patient population, which has typically been regarded as not being the best candidates for lung transplantation. Upon analyzing patient outcomes, the researchers found that the survival rates between older and young patients were not all that different, especially at the 30-day survival period, and they concluded that this elderly patient population should not be categorically excluded from being offered the procedure as a treatment option. In the study just released in JACS, the researchers are able to make more specific recommendations for patients in the 60 to 70-years of age range, and beyond.
This new retrospective study examined 8,363 adult patients who underwent lung transplantation between 1999 and 2006. The United Network for Organ Sharing (UNOS) database provided the data, which was stratified into four quartiles (Q) of age: Q1, 18 to 45 years; Q2, 46 to 55 years; Q3, 56 to 60 years; Q4, 61 to 79 years. Patients in Q4 were further examined in smaller increments of age to assess differences in outcomes among the oldest groups of transplant recipients.
Patients in all four age quartiles had similar 30-day and 90-day mortality rates, but patients in Q4 experienced the highest mortality rates at 1-year post-transplant (21.4 percent, p=0.002). Of the 57 patients identified as 70 or older, 34 percent of the patients died during the study period. Additionally, both the 90-day and the 1-year mortality rates of the 70 years or older cohort was significantly higher than those patients under 70 (27 percent versus 9 percent for 90 day; and 42 percent versus 18 percent for 1 year; p< 0.001 for both comparisons).
Weber Shandwick Worldwide
This new research study in JACS expands on previous findings reported by Dr. Weiss and colleagues. In October 2007 (93rd annual Clinical Congress Congress of the American College of Surgeons), Dr. Weiss reported that lung transplants improved survival rates in patients over 60 years of age. In this previous study the Johns Hopkins researchers looked at factors that create positive results in a 60-plus patient population, which has typically been regarded as not being the best candidates for lung transplantation. Upon analyzing patient outcomes, the researchers found that the survival rates between older and young patients were not all that different, especially at the 30-day survival period, and they concluded that this elderly patient population should not be categorically excluded from being offered the procedure as a treatment option. In the study just released in JACS, the researchers are able to make more specific recommendations for patients in the 60 to 70-years of age range, and beyond.
This new retrospective study examined 8,363 adult patients who underwent lung transplantation between 1999 and 2006. The United Network for Organ Sharing (UNOS) database provided the data, which was stratified into four quartiles (Q) of age: Q1, 18 to 45 years; Q2, 46 to 55 years; Q3, 56 to 60 years; Q4, 61 to 79 years. Patients in Q4 were further examined in smaller increments of age to assess differences in outcomes among the oldest groups of transplant recipients.
Patients in all four age quartiles had similar 30-day and 90-day mortality rates, but patients in Q4 experienced the highest mortality rates at 1-year post-transplant (21.4 percent, p=0.002). Of the 57 patients identified as 70 or older, 34 percent of the patients died during the study period. Additionally, both the 90-day and the 1-year mortality rates of the 70 years or older cohort was significantly higher than those patients under 70 (27 percent versus 9 percent for 90 day; and 42 percent versus 18 percent for 1 year; p< 0.001 for both comparisons).
Weber Shandwick Worldwide
Lung Transplantation Current Events and Lung Transplantation News RSSUC San Diego researchers reverse pulmonary arterial hypertension in mouse models
Researchers at the University of California, San Diego, have identified a key protein that promotes the development of pulmonary arterial hypertension in humans and mice.
Important new novel 2009 H1N1 flu advisory for cardiopulmonary transplantation
Each year 3-5 million people have severe cases and 250-500,000 die from complications of seasonal influenza world-wide. This year, the novel 2009 H1N1 (nH1N1) influenza, previously called swine flu, has reached pandemic status.
Protein may be strongest indicator of rare lung disease, study shows
Researchers at the University of Cincinnati (UC) have discovered a protein in the lungs that can help in determining progression of the rare lung disease Idiopathic Pulmonary Fibrosis (IPF).
More stringent evaluation on the use of generic medications in thoracic transplantation
A closer look at regulatory and clinical concerns with generic immunosuppression medications in thoracic transplantation is required.
Breathing life into injured lungs: World-first technique will expand lung donor organ pool
For the first time in the world, transplant surgeons at Toronto General Hospital, University Health Network used a new technique to repair an injured donor lung that was unsuitable for transplant, and then successfully transplanted it into a patient.
UT Southwestern researchers identify gene linked to inherited form of fatal lung disease
Researchers at UT Southwestern Medical Center have determined that a mutation in a gene known for its role in defending the lungs against invading pathogens is responsible for some inherited cases of a lethal lung disease affecting older adults. The same mutation may also be associated with lung cancer, the researchers said.
Biomarkers identified for idiopathic pulmonary fibrosis
The first evidence of a distinctive protein signature that could help to transform the diagnosis and improve the monitoring of the devastating lung disease idiopathic pulmonary fibrosis (IPF) is being reported by University of Pittsburgh School of Medicine researchers in this month's edition of PLoS Medicine, an open-access journal of the Public Library of Science.
Lung transplants in cystic fibrosis patients with life-threatening bacteria sparks debate at ISHLT
During Wednesday's Satellite Symposium 3: The Challenges of Lung Transplantation in Cystic Fibrosis (CF) at the International Society of Heart and Lung Transplantation (ISHLT) Annual Meeting & Scientific Sessions, clinicians and researchers discussed some of the unique challenges in achieving excellent lung transplant outcomes in patients with CF.
Biomarkers may reduce need for biopsies
Data presented at this week's 28th Annual Meeting and Scientific Sessions of the International Society for Heart and Lung Transplantation (ISHLT) suggest the potential of a significant impact of using biomarkers to reduce the need for biopsies and personalize transplant patient care.
Henry Ford Hospital to study effectiveness of a new procedure that may help emphysema suffers
Researchers at Henry Ford Hospital today announced the start of the EASE (Exhale Airway Stents for Emphysema) Trial, an international, multi-center clinical trial to explore an investigational treatment that may offer a significant new option for those suffering with advanced emphysema.
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The Lung Transplantation Handbook: A Guide For Patients, Second Edition by Karen A. Couture (Author) 'The Lung Transplantation Handbook (Second Edition)', originally published under the title 'Things You Should Know About Lung Transplantation: Before, During and After' has now been updated and expanded in this, the second edition. This comprehensive, 270-page book, written by lung transplant recipient Karen A. Couture, covers the entire transplantation process from beginning to end for both lung and heart-lung transplants. This book introduces the reader, in easy-to-understand language, to the complex process of getting on the transplant waiting list and how the list works; preparing for surgery and the surgery itself; financing the operation and the recovery afterward; and the complications of rejection and the medications. It also includes precautions a transplant recipient... |
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