A lung transplant replaces diseased lungs with healthy donor lungs. It is considered for severe lung conditions when other treatments fail, offering extended life and enhanced well-being for patients with end-stage pulmonary disease. This procedure has become a recognized medical standard for selected patients globally.
Age and Transplant Eligibility
While lung transplantation was once primarily reserved for younger individuals, medical advancements have significantly broadened eligibility, including for older adults. Historically, strict age cut-offs were common, but the focus has shifted from chronological to physiological age, assessing overall health and functional capacity. The number of lung transplant procedures for patients aged 65 and older has substantially increased, reflecting improved outcomes.
Current international guidelines no longer suggest a fixed upper age limit for candidates. Instead, suitability is determined by a patient’s overall health and ability to withstand the procedure and recovery. Some centers, for example, consider individuals up to age 75 as potential candidates. This evolving perspective acknowledges that many older adults maintain good health and functional reserves, making them suitable recipients.
Comprehensive Patient Assessment
Evaluating a potential lung transplant candidate involves a thorough, multidisciplinary assessment beyond age. A team of specialists, including pulmonologists, cardiologists, surgeons, and social workers, reviews a patient’s medical history and current health. This comprehensive evaluation assesses major organ functions (heart, kidneys, liver) to ensure they can withstand surgery and lifelong medication. Diagnostic tests like pulmonary function tests, imaging scans, and cardiac evaluations are routinely performed.
Nutritional status is assessed, with guidance provided to achieve a healthy body weight, as malnutrition or obesity can affect surgical outcomes. Active infections or cancers must be absent due to significant risks during and after transplantation. A psychosocial evaluation assesses mental health, coping mechanisms, and understanding of the demanding post-transplant care. A strong support system is essential, as caregivers play a crucial role in managing post-operative care and daily needs.
The Transplant Process for Older Adults
Eligible candidates are placed on a national waiting list, managed by organizations like the United Network for Organ Sharing (UNOS) in the United States. Organ allocation is determined by factors like:
Blood type
Body size
Medical urgency
Lung Composite Allocation Score (Lung CAS)
This score prioritizes patients based on medical need and likelihood of successful outcomes. While on the waiting list, patients must remain available and ready for transplant, often staying near the transplant center.
When a suitable donor lung becomes available, the patient is called for surgery. Lung transplant surgery typically lasts 4 to 12 hours, involving removal of diseased lung(s) and connection of donor lung(s) to airways and blood vessels. During the operation, some patients may be connected to a heart-lung bypass machine for circulation and oxygenation.
Older recipients may require more intensive post-operative monitoring due to reduced physiological reserves. While initial hospital stays might be similar, older recipients may have higher readmission rates within the first 30 or 90 days.
Post-Transplant Considerations and Outlook
Life after a lung transplant requires lifelong medical regimens and ongoing care, primarily immunosuppression with daily medications to prevent organ rejection. These medications, often a combination of a calcineurin inhibitor, an anti-metabolite, and corticosteroids, help maintain organ acceptance. While effective, immunosuppressants carry potential side effects, including increased susceptibility to infections, kidney dysfunction, and new-onset diabetes.
Rehabilitation, including pulmonary and regular exercise, is crucial for regaining strength and improving lung function. Older recipients often experience significant quality of life improvements, breathing easier and increasing activity levels.
However, survival rates vary with age. For recipients aged 70 and older, one-year survival rates are around 83-84%, with three-year rates around 60-62%. These outcomes are generally lower than for younger recipients. Older patients may face increased risks of complications like infection, malignancy, or cardiovascular issues over time. Consistent adherence to medication, regular follow-up, and a healthy lifestyle are paramount for long-term success.