The Science Journal of the American Association for Respiratory Care

2007 OPEN FORUM Abstracts

OUTCOMES IN PATIENTS 65 YEARS OF AGE OR OLDER FOLLOWING LUNG TRANSPLANTATION

C. A. Hoerr1, 2, D. G. Biggar2, D. Clinkscale1, 2, E. Trulock3, G. A. Patterson3


Background: Lung transplantation (LTX) is a therapeutic option for patients with end stage lung disease. Advanced recipient age has been associated with poor outcome following LTX. Age greater than 55 has been a relative contraindication in many LTX programs. Recently, advanced age has been suggested to not be a contraindication to LTX in otherwise appropriate recipients. The purpose of this study was to evaluate type of transplant procedure (bilateral lung transplant-blt, single lung transplant-slt) 90 day mortality, length of stay (LOS), and functional ability as measured by the six minute walk test (6MW) in a group of patients aged 65 or older at time of transplant (Group 1) compared to a similar group aged less than 65 at time of transplant (Group 2).

Method: Retrospective review of transplant procedure, 90 day mortality, mean LOS and 6MW distance of these two groups of patients transplanted between January, 1997 and November, 2006.
Population: Group 1 consisted of 24 patients (11 females, 13 males) with a mean age of 65.8 years. Diagnoses included COPD (15) and idiopathic pulmonary fibrosis (9). Group 2 consisted of 24 patients (11 females, 13 males) with a mean age of 54.8 years. Diagnoses included COPD (15) and idiopathic pulmonary fibrosis (9). Diagnostic information gathered prior to LTX is as follows:
Group 1: FEV1 (Mean %) = 32, FVC (Mean %) = 54, TLC (Mean %) = 92, Mean 6MW distance = 1040 ft; Group 2: FEV1 (Mean %) = 32, FVC (Mean %) = 52, TLC (Mean %) = 101, Mean 6MW distance = 1007 ft.
Interventions: All patients participated in pulmonary rehabilitation (PR) pre transplant. Surviving patients participated in PR following transplant. PR included supervised endurance exercise training either on a treadmill or cycle ergometer for 30 continuous minutes, 3-5 days/week. All patients underwent LTX. One patient was re-transplanted in Group 1 for primary graft failure on day 21.

Results: See Table.

Conclusions: Group 1 had a longer LOS compared to Group 2 but Group 1 had two outliers with a combined LOS of 410 days. The mean LOS without the ouliers was 19.1, similar to Group 2. Transplant in patients aged 65 or greater in appropriate recipients is feasible with acceptable outcomes.

Results
  SLT BLT 90 Day Mortality Mean LOS (days)Mean 6MW (ft) 12 weeks post LTX
Group 1 6 19 1 34.6 1242
Group 2 2 22 0 19.6 1450



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