Review of Lung Transplantation for Patients 65 Years and Older with Idiopathic Pulmonary Fibrosis in Ireland

Abstract

Purpose The first lung transplant (LTX) was performed in Ireland in 2005 in the MMUH, Dublin. Since the establishment of this programme there have been 243 LTX. LTX is the only effective treatment for Idiopathic Pulmonary Fibrosis (IPF). IPF has an average age of diagnosis of 66 years (yrs) and a median survival of 2.5 to 3.5 yrs (Ley et al., 2010). This demonstrates the need for LTX not only in this disease but also this age group. Advanced age is reported to negatively affect survival post LTX (Smith et al., 2006). We hypothesized that LTX in patients with IPF aged ≥ 65 yrs could be performed with acceptable outcomes. Methods A retrospective review of patients ≥ 65 yrs of age with IPF who received a LTX in the MMUH between 2008 and 2018. Electronic and paper patient records were reviewed and outcomes were analysed. Results To date 19.3 % (47/243) of LTX recipients in Ireland were ≥ 65 yrs. Of these 85.1% (40/47) had a diagnosis of IPF. The IPF group consisted of 77.5 % males (n=31) and 22.5% females (n=9) with a mean age of 66.7 yrs (range, 65 to 75 yrs). All recipients received single LTX, 50% received a left LTX and 50% received a right LTX. 1 died pre extubation, 3 intubated Conclusion Many lung transplant centres do not assess or transplant patients ≥ 65 yrs of age on the basis of poorer outcomes in this population. However it is evident from the analysed survival data that survival rates of this older IPF transplant recipient population is favourable when compared to the overall lung transplant survival rates reported by the ISHLT in 2017, of 80.47 % at 1 yr, 64.99% at 3 yrs and 53.42% at 5 yrs (ISHLT, 2017). This should encourage other centres to extend their cohort of patients considered for LTX assessment.