Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Sep;9(3):149-159.
doi: 10.1007/s40472-022-00365-2. Epub 2022 Apr 21.

The Intersection of Aging and Lung Transplantation: its Impact on Transplant Evaluation, Outcomes, and Clinical Care

Brittany Koons  1 , Michaela R Anderson  2 , Patrick J Smith  3 , John R Greenland  4   5 , Jonathan P Singer  6
Affiliations

The Intersection of Aging and Lung Transplantation: its Impact on Transplant Evaluation, Outcomes, and Clinical Care

Brittany Koons et al. Curr Transplant Rep. 2022 Sep.

Abstract

Purpose: Older adults (age ≥ 65 years) are the fastest growing age group undergoing lung transplantation. Further, international consensus document for the selection of lung transplant candidates no longer suggest a fixed upper age limit. Although carefully selected older adults can derive great benefit, understanding which older adults will do well after transplant with improved survival and health-related qualiy of life is key to informed decision-making. Herein, we review the epidemiology of aging in lung transplantation and its impact on outcomes, highlight selected physiological measures that may be informative when evaluating and managing older lung transplant patients, and identify directions for future research.

Recent findings: In general, listing and transplanting older, sicker patients has contributed to worse clinical outcomes and greater healthcare use. Emerging evidence suggest that measures of physiological age, such as frailty, body composition, and neurocognitive and psychosocial function, may better identify risk for poor transplant outcomes than chronlogical age.

Summary: The evidence base to inform transplant decision-making and improvements in care for older adults is small but growing. Multipronged efforts at the intersection of aging and lung transplantation are needed to improve the clinical and patient centered outcomes for this large and growing cohort of patients. Future research should focus on identifying novel and ideally modifiable risk factors for poor outcomes specific to older adults, better approaches to measuring physiological aging (e.g., frailty, body composition, neurocognitive and psychosocial function), and the underlying mechanisms of physiological aging. Finally, interventions that can improve clinical and patient centered outcomes for older adults are needed.

Keywords: Aging; Body composition; Frailty; Lung transplantation; Neurocognitive function; Psychosocial function.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Brittany Koons, Michaela Anderson, Patrick Smith, and Jonathan Singer have no relevant financial or non-financial interests to disclose. John Greenwood has served on advisory boards for Boehringer Ingelheim, Theravance Biopharma, and Atara Bio-therapeutics and has received research funding from Thermo Fisher Scientific, BioFire Diagnostics, and Theravance Biopharma.

Similar articles

See all similar articles

Cited by

  • Prehabilitation in Adult Solid Organ Transplant Candidates.
    Quint EE, Ferreira M, van Munster BC, Nieuwenhuijs-Moeke G, Te Velde-Keyzer C, Bakker SJL, Annema C, Mathur S, Pol RA. Quint EE, et al. Curr Transplant Rep. 2023;10(2):70-82. doi: 10.1007/s40472-023-00395-4. Epub 2023 Mar 25. Curr Transplant Rep. 2023. PMID: 37124070 Free PMC article. Review.

References

    1. Valapour M, et al. OPTN/SRTR 2019 Annual Data Report: Lung. Am J Transplant. 2021;21(Suppl 2):441–520. 10.1111/ajt.16495. - DOI - PubMed
    1. Chambers DC, et al. The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: Thirty-Eighth Adult Lung Transplantation Report - 2021; Focus on recipient characteristics. J Heart Lung Transplant. 2021;40(10):1060–72. 10.1016/j.healun.2021.07.021 - DOI - PMC - PubMed

    2. This report from ISHLT focuses on changes in lung transplant recipient factors over the past 3 decades, identifying important characteristics and transplant processes that may influence post-transplant outcomes.

    1. Valapour M, et al. OPTN/SRTR 2016 Annual Data Report: Lung. Am J Transplant. 2018;18(Suppl 1):363–433. 10.1111/ajt.14562. - DOI - PubMed
    1. Yusen RD, et al. The Registry of the International Society for Heart and Lung Transplantation: Thirtieth Adult Lung and Heart-Lung Transplant Report–2013; focus theme: age. J Heart Lung Transplant. 2013;32(10):965–78. 10.1016/j.healun.2013.08.007. - DOI - PubMed
    1. Mulligan MS, et al. National Heart, Lung, and Blood Institute and American Association for Thoracic Surgery Workshop Report: Identifying collaborative clinical research priorities in lung transplantation. J Thorac Cardiovasc Surg. 2018;156(6):2355–65. 10.1016/j.jtcvs.2018.08.010. - DOI - PMC - PubMed