If you’re considering a lung transplant, it’s important to be in the best shape possible. That includes being evaluated in a pulmonary rehabilitation program, eating healthy and taking all your medicines. You will also need to stay close to a hospital for appointments, blood tests and follow-up exams.
CU general surgery residents John Iguidbashian and Alejandro Suarez-Pierre recently studied mortality rates between lung transplant patients and adults who didn’t receive a lung transplant. They found some interesting facts about survival rates by age.
1. The Age of the Donor
The age of the donor plays a significant role in lung transplantation survival. In order to allocate scarce lung allografts as effectively as possible, it is essential that we consider all factors affecting outcomes, including donor age.
The aging process is associated with an increase in morbidity and mortality, particularly pulmonary diseases. It is important to evaluate donors for pulmonary disease before donating organs. This includes evaluation for common malignancies and routine screening for chronic obstructive airway disease. wwe legends
During the first few months after surgery, you will have frequent appointments with your care team to monitor the condition of your new lungs. It is best to live within an hour of your care center. This is so you can receive treatment quickly if you develop any complications.
However, age is not an absolute contraindication to donation. Anyone can sign up to become an organ, tissue and cornea donor. The medical professionals who decide on your eligibility for donation will assess your health and lifestyle and take your age into consideration when making this decision upon your death.
2. The Age of the Recipient
A lung transplant is a complex procedure, but UF Health Shands Hospital is one of the best programs in the country for one-year risk-adjusted survival rates. In fact, the program ranks at No. 2 nationally according to the Scientific Registry of Transplant Recipients (SRTR).
However, a person’s aging will also affect their survival rate after lung transplantation. For example, older recipients have a greater risk of posttransplant complications due to immunosenescence. This is a gradual deterioration of the body’s immune system that occurs with advancing age.
The risk of rejection is also higher in older recipients. This is because the immune system sees a new organ as foreign, like a splinter in your finger. To prevent rejection, people who receive a lung transplant must take medications to suppress their immune response.
A recent study of donor-recipient age combinations found that a pragmatic approach to using older lung allografts could improve long-term outcomes in septuagenarians. This approach includes a careful assessment of the candidate, including serology, size and immunology. It also involves a discussion with the donor’s family about what his or her wishes are regarding donating to a septuagenarian recipient.
3. The Age of the Surviving Lung
The age of the surviving lung in a transplant recipient also has a significant impact on outcomes. One study published in 2007 compared 1-year survival between older (defined as >60 years of age) and younger recipients, and found that the elderly group had significantly worse outcomes primarily due to infection and graft failure.
Other comorbidities that increase with age also have the potential to adversely affect transplant outcomes. These include cancer, which has a higher incidence in the elderly and is more difficult to treat with aggressive chemo- and radiation therapy regimens. There is also a greater likelihood of acute cellular rejection requiring augmented immunosuppression in the elderly.
In addition to these comorbidities, age related general physiologic changes can limit pulmonary function and complicate the evaluation of candidates for LTx. In particular, reduced pulmonary elasticity, dependent zone airway closure, and loss of muscle mass will all contribute to impaired respiratory performance. These factors must be carefully evaluated in any candidate for LTx to ensure that the benefits are outweighed by the risks.
4. The Age of the Recipient’s Heart
While age will certainly factor into the decision to accept or reject a lung transplant, the individual patient’s life expectancy should be taken into consideration. Frequently, patients seeking a lung transplant are in the late stages of end-stage respiratory disease. For such individuals, symptom relief is of paramount concern and the known prognostic limitations germane to lung transplantation may appear acceptable.
The retrospective outcomes available in ISHLT and UNOS lung transplant registries often divide candidates into arbitrarily selected categories of recipients by age (>60 years and separately >65 years). Unfortunately, this type of analysis does not account for biological variances inherent to aging.
However, it has been shown in risk-adjusted multivariate models that age 70 years or older no longer serves as an absolute contraindication to LTx in the postlung allocation score era. In fact, a significant proportion of septuagenarians underwent LTx and achieved comparable 1-year survival to the 60-69 year-old cohort. This suggests that it may be time to consider changing the way we view aging in the context of lung transplantation.
5. The Age of the Recipient’s Blood
As you age, your body’s immune system slows down. This may cause your organs to reject the new lung. This is the most common reason for lung transplant failure.
The risk of rejection peaks in the first year after lung transplantation and steadily declines over time. It is higher for women, Hispanic people, and those with cystic fibrosis and immunodeficiency disorders. The risk also rises with each additional red blood cell transfusion.
If you receive a lung transplant, you will need to take immunosuppressants to prevent your body from rejecting the new lung. These drugs raise your risk of infection, especially viral and bacterial pneumonia.
However, recent studies show that select patients age 65 and older can safely undergo lung transplant surgery and have acceptable outcomes. Those interested in receiving a lung transplant should talk to their pulmonologist. They will perform a battery of interviews and tests to determine whether you are a good candidate for the procedure. If you are, they will recommend you to a transplant center. This will include a multidisciplinary team of specialists.
6. The Age of the Recipient’s Bones
The recovery process for lung transplantation can take up to six months. During this time, you will need to visit your transplant center for many appointments and follow-up care. Keeping yourself in good health can help prevent serious complications. This includes not smoking, exercising regularly, and getting routine cancer screenings. In addition, you should also follow your doctor’s treatment plan and avoid medications that can cause organ rejection.
While age was associated with increased posttransplantation mortality in the pre-lung allocation score era, it no longer serves as an absolute contraindication to transplantation. This is especially true in a patient group where symptom relief is deemed the most important benefit of transplantation.
A study examining data from the ISHLT registry found that older patients with a higher LAS at listing had a much shorter median wait time than those with a low LAS. However, the number of patients in each LAS group was small, making trend analysis difficult. Regardless, it is important for surgeons to discuss the benefits and risks of lung transplantation with each patient, including their age.
7. The Age of the Recipient’s Skin
Lung transplant recipients are at a higher risk for skin cancer due to the immunosuppressive medications they must take, such as azathioprine and mycophenolate. Because of this, it’s important for them to use sunscreen with SPF 55 or higher and wear hats and long sleeves when going outdoors. It’s also helpful to have a dermatologist who examines their skin every six months for pre-cancerous lesions. The doctor will then share their findings with the transplant team.
In addition to staying physically healthy, patients preparing for lung transplant should stay socially and emotionally strong as well. This can be accomplished through in-person support groups, therapists, and faith communities.
A pulmonary rehabilitation program is another great way to build strength, and patients should be prepared for a lengthy hospital stay. This is especially true for cadaver lung transplants, where the patient will be under general anesthesia and placed on a heart-lung machine. For this reason, it’s important that the patients have family and friends nearby to keep them company, provide support, and help with errands and transportation.
8. The Age of the Recipient’s Immune System
Lung transplant recipients must take medicines to keep their bodies from rejecting the donated lung(s). These immunosuppressants increase cancer risk. They also can cause other health problems, such as infections, liver disease, and cognitive issues. In addition, they can increase the risk of death from heart attacks, pneumonia, and other cardiovascular diseases.
Age-specific outcomes are often reported by ISHLT registries and UNOS using arbitrarily defined age categories (60 years, and separately 65 years). These data do not include biological variances of patients at different ages.
For new patients listed for lung transplantation, median wait times have declined significantly since implementation of the lung allocation score. However, the number of new registrants who are 60 to 64 years of age is increasing, while that of patients 65 and older has not changed much. This increase in the number of older lungs placed on the list may contribute to a shortened life expectancy after lung transplantation. Moreover, a shorter life expectancy can lead to decreased quality of life, which is especially important for elderly recipients.