Who is too old to receive a lung transplant?

“There is no clear answer at this time. Nor was there a clear answer when the guidelines for lung transplantation// were written in 1998. They were based on the best clinical data then available,” explained Dr. Philip W. Smith, a surgery resident and research fellow at the University of Virginia Health System.

Since lung transplantation (LTX) was first performed in 1983, it has been a viable therapy for patients with progressive end-stage lung disease. However, transplant centers have found it necessary to adhere to patient age restrictions for LTX because supplies of donor organs are scarce and mortality risks for the elderly are high.

While they have risen in recent years, the recommended age limits for LTX are now 60 for bilateral lung transplantation (BLT) and 65 for single-lung transplantation (SLT). These guidelines are based on the experience of academic institutions such as UVa, which is among several centers now exploring if further revisions are reasonable.

According to Smith, age restrictions are a pressing issue for the medical community because the number of people age 60 and older is growing rapidly, and this group will soon constitute a quarter of the U.S. population.

Smith said that he and Dr. David R. Jones, surgical director of UVa’s Lung Transplant Program, were concerned about categorically excluding the elderly from receiving LTX. “This concern prompted the retrospective study we recently completed,” Smith said.

Published last month in The Annals of Thoracic Surgery, the study reviewed the outcomes of 182 LTX recipients treated at UVa between 1995 and 2005. Of those patients, 52 (or 29 percent) were between 60 and 69 years old. Sixteen patients (or 9 percent) were aged 65 or older.

“Age is not an independent exclusion criterion at our center,“ noted Jones. “All patients undergo the same pre-transplant evaluation to de
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