Fischer S, Meyer K, Tessmann R, Meyer A, Gohrbandt B, Simon A, Hagl C, Kallenbach K, Haverich A, Strüber M
Hannover Thoracic Organ Transplant Program, Division of Thoracic and Cardiovascular Surgery Hannover Medical School, Hannover, Germany.
Transplant Proc. 2005 Mar;37(2):1369-70. doi: 10.1016/j.transproceed.2004.12.269.
The significant shortage of donor organs in lung transplantation necessitates a careful selection of lung transplant recipients. The outcome of lung transplant recipients aged 60 years and older has not been analyzed systematically.
We retrospectively reviewed our experience with older recipients. Between January 1999 and July 2003, 248 patients underwent lung transplantation at our institution, of which 18 were aged 60 years and older (7.3%, range 60-66, mean 62 +/- 1.1).
Eleven (61%) of the recipients 60 years and older received a single (SLTx) and seven (39%), a bilateral lung transplant. Donor age in the single transplant cohort was 30 +/- 4 years. It was 33 +/- 3 years in bilateral patients. Posttransplant ventilation time was significantly different among groups, with 282 +/- 32 hours after bilateral and 56 +/- 13 hours after transplant (P < .05). Also significantly longer was the length of the ICU stay in the bilateral group. First PaO2 in the ICU was not different among the two groups. The 1-year survival in the single transplant group was significantly better compared to the bilateral group with 73% versus 43%, respectively.
The 1-year survival following lung transplantation in patients older than 60 years is markedly reduced compared to recipients under 60 years of age. If a lung transplant is considered in a recipient above the age of 60 years, a single transplant should be favoured. If that is not indicated, patients over 60 should be very carefully selected for bilateral transplant.
肺移植中供体器官的严重短缺使得必须仔细挑选肺移植受者。60岁及以上肺移植受者的结局尚未得到系统分析。
我们回顾性分析了我们在老年受者方面的经验。1999年1月至2003年7月期间，我们机构有248例患者接受了肺移植，其中18例年龄在60岁及以上（7.3%，范围60 - 66岁，平均62±1.1岁）。
60岁及以上的受者中，11例（61%）接受了单肺移植（SLTx），7例（39%）接受了双肺移植。单肺移植组供体年龄为30±4岁。双肺移植患者为33±3岁。各组术后通气时间差异显著，双肺移植后为282±32小时，单肺移植后为56±13小时（P <.05）。双肺移植组的重症监护病房（ICU）住院时间也显著更长。两组在ICU的首次动脉血氧分压（PaO2）无差异。单肺移植组的1年生存率明显高于双肺移植组，分别为73%和43%。
与60岁以下的受者相比，60岁以上患者肺移植后的1年生存率显著降低。如果考虑为60岁以上的受者进行肺移植，应优先选择单肺移植。如果不适合单肺移植，则对于60岁以上的患者进行双肺移植时应非常谨慎地挑选。
