From the Guidelines
Lung transplant age limits are generally considered to be up to 65 years old, but can be extended to 70 years or older on a case-by-case basis, with a focus on physiological rather than chronological age. The evaluation process for lung transplant candidacy assesses overall health status, including cardiovascular health, absence of significant comorbidities, adequate physical functioning, and strong social support 1. Older patients must demonstrate good functional capacity and rehabilitation potential. Age limits exist because outcomes tend to be better in younger recipients, and organs are allocated to maximize benefit. The transplant evaluation includes extensive testing of lung function, heart health, kidney and liver function, bone density, and psychological assessment.
Some key points to consider in the evaluation process include:
- The presence of severe functional impairment, oxygen dependency, and a deteriorating course despite optimal medical management 1
- The absence of significant extrapulmonary disorders, such as liver, renal, or cardiac dysfunction, that may negatively influence survival 1
- The patient's ability to maintain optimal health while awaiting transplant, including following medical advice, participating in pulmonary rehabilitation, maintaining nutrition, and avoiding infections
- The consideration of bilateral lung transplantation as a better option than single lung transplantation, especially for patients younger than 60 years 1
It's worth noting that the decision to list patients for transplantation is made by a multidisciplinary team that considers the individual's complete health profile, rather than age alone 1. Ultimately, the goal of lung transplantation is to improve quality of life and survival, and the evaluation process is designed to identify patients who are most likely to benefit from this treatment.
From the Research
Age Limits for Lung Transplantation
- The age limit for lung transplantation is not strictly defined, but rather considered on a case-by-case basis, taking into account the patient's overall health and suitability for the procedure 2, 3, 4.
- Studies have shown that lung transplantation can be successfully performed in patients aged 65 years and older, with similar outcomes to those of younger patients 2, 3, 4.
- A study published in 2020 reported a one-year survival rate of 76% in patients aged 65 years and older who underwent lung transplantation 2.
- Another study published in 2011 found no significant difference in short- or long-term outcomes between patients under 60 years old and those 60 years old or older who underwent lung transplantation 3.
- A 2024 study compared outcomes between patients older than 65 years and those younger than 65 years who underwent lung transplantation, and found no significant difference in 90-day mortality, 1-year mortality, or 5-year overall survival 4.
- The use of frailty scales has been proposed as a selection criterion to identify older patients who may be at higher risk of poor outcomes after lung transplantation 5.
Considerations for Older Patients
- Older patients undergoing lung transplantation may require more careful selection and management, taking into account their overall health and any pre-existing comorbid conditions 6.
- A study published in 2022 highlighted the importance of proper management during the pre-transplantation period, including nutrition, pulmonary rehabilitation, and psychological support, to optimize outcomes in older patients 6.