Alla Avramenko , Harry Etienne , Gaëlle Weisenburger , Jimmy Mullaert , Pierre Cerceau , Quentin Pellenc , Arnaud Roussel , Lise Morer , Vincent Bunel , Philippe Montravers , Hervé Mal , Yves Castier , Jonathan Messika , Pierre Mordant , Bichat Lung Transplant Group
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Two groups were defined depending on the patients’ age when they were transplanted: patients older than 65 were defined as the “elderly group” and patients younger than 65 years old were defined as the « younger group ». Primary endpoint was 90-day mortality. Secondary endpoints included 1-year mortality, 1-year FEV1 (forced expiratory volume in one second), and 5-year overall survival.</p></div><div><h3>Results</h3><p>From September 2014 to March 2019, 22 patients were included in the “elderly group” and 213 were included in the « younger group ». The elderly group had more single LT (SLT) (82% vs. 29%, <em>p</em> < 0.001), with a shorter cold ischemic time (243 min vs. 310 min, <em>p</em> = 0.001) and a lower rate of early humoral rejection (9% vs. 30%, <em>p</em> = 0.045) compared to the younger group. Ninety-day mortality was not significantly different between elderly and younger group (9% vs. 14%, <em>p</em> = 0.95, respectively), nor were 1-year mortality (23% vs. 25%, <em>p</em> = 0.9, respectively) and 5-year overall survival. Six months after LT, FEV1 was significantly better in the elderly group compared to the younger group (77.0% vs. 65.5%, <em>p</em> = 0.037 respectively), but the difference did not reach statistical significance after one year (78.5 vs. 68.3%, <em>p</em> = 0.18 respectively).</p></div><div><h3>Conclusion</h3><p>Elderly patients underwent more frequently single LT, and achieved similar short and long term postoperative outcomes compared to their younger counterparts. 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引用次数: 0
摘要
导言随着高容量中心经验的增加，年龄本身不应成为肺移植（LT）的绝对禁忌症，而应作为患者初始特征的一部分加以考虑。本研究的目的是提供 65 岁或以上受者与年轻受者肺移植的早期和长期疗效对比。方法这是一项回顾性研究，包括 2014 年 1 月至 2019 年 3 月期间在比夏特医院（法国巴黎）接受肺移植的所有患者。根据患者接受移植时的年龄分为两组：65岁以上的患者被定义为 "老年组"，65岁以下的患者被定义为 "年轻组"。主要终点是 90 天死亡率。次要终点包括1年死亡率、1年FEV1（1秒内用力呼气容积）和5年总生存率。结果从2014年9月到2019年3月，22名患者被纳入 "老年组"，213名患者被纳入 "年轻组"。与年轻组相比，老年组的单次LTT（SLT）更多（82% vs. 29%，p <0.001），冷缺血时间更短（243 min vs. 310 min，p = 0.001），早期体液排斥率更低（9% vs. 30%，p = 0.045）。老年组和年轻组的90天死亡率（分别为9%和14%，P = 0.95）、1年死亡率（分别为23%和25%，P = 0.9）和5年总存活率均无明显差异。LT术后6个月，老年组的FEV1明显优于年轻组（分别为77.0% vs. 65.5%，p = 0.037），但一年后差异未达到统计学意义（分别为78.5% vs. 68.3%，p = 0.18）。65岁或以上的患者在经过慎重选择后，应常规考虑接受LT手术。
How safe is lung transplantation in patients of 65 years or older? A single-center retrospective cohort
Introduction
With increasing experience in high-volume centers, age alone should not be an absolute contra-indication to lung transplantation (LT) but be considered as part of the patient's initial characteristics. The objective of this study is to provide early and long-term outcomes of LT in recipients aged 65 or older, compared with their younger counterparts.
Methods
This is a retrospective study, including all patients undergoing LT in Bichat Hospital (Paris, France) from January 2014 to March 2019. Two groups were defined depending on the patients’ age when they were transplanted: patients older than 65 were defined as the “elderly group” and patients younger than 65 years old were defined as the « younger group ». Primary endpoint was 90-day mortality. Secondary endpoints included 1-year mortality, 1-year FEV1 (forced expiratory volume in one second), and 5-year overall survival.
Results
From September 2014 to March 2019, 22 patients were included in the “elderly group” and 213 were included in the « younger group ». The elderly group had more single LT (SLT) (82% vs. 29%, p < 0.001), with a shorter cold ischemic time (243 min vs. 310 min, p = 0.001) and a lower rate of early humoral rejection (9% vs. 30%, p = 0.045) compared to the younger group. Ninety-day mortality was not significantly different between elderly and younger group (9% vs. 14%, p = 0.95, respectively), nor were 1-year mortality (23% vs. 25%, p = 0.9, respectively) and 5-year overall survival. Six months after LT, FEV1 was significantly better in the elderly group compared to the younger group (77.0% vs. 65.5%, p = 0.037 respectively), but the difference did not reach statistical significance after one year (78.5 vs. 68.3%, p = 0.18 respectively).
Conclusion
Elderly patients underwent more frequently single LT, and achieved similar short and long term postoperative outcomes compared to their younger counterparts. LT for patients 65 years or older should be routinely considered when carefully selected.
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