Thursday, April 24, 2014
IPF and Lung Transplant 69 yo
I have early IPF, O2 required while walking. I`m a 69yo retired physician, and was in perfect health prior the IPF. I know some programs will make exceptions for good physical condition, on an individual basis, and some programs like the Cleveland Clinic accept patients to 70yo.
1. Are you aware of any other programs accepting older applicants?
2. I probably won`t need a transplant for a couple of years, as a general policy, if you are enrolled in a program before their public cut off date, would they still proceed with a transplant (assuming no other new diseases)?
Because there is no cure for idiopathic pulmonary fibrosis, lung transplant is a consideration for patients who meet transplant criteria. The main contraindications (conditions that preclude transplant) are:
- uncontrolled infection
- HIV infection
- hepatitis B or C
- active tobacco smoking, drug or alcohol dependency
- significant chest wall or spinal deformity
- psychosocial problem
- noncompliance with medical therapy, and
- absence of an adequate psychosocial support system.
Obesity, as defined as a body mass index (BMI) greater than 30 is generally considered a contraindication as well.
Although age over 65 years has been a cut-off at many centers in the past, age alone is not an absolute contraindication at all transplant centers, and so patients older than 65 have undergone transplant. However, the survival of patients over 65 after lung transplant is shorter than the survival of patients under 65 after lung transplant.
Lung transplantation is very expensive, and so the first step is frequently to check with your insurance company to see if they cover lung transplant and if there are any restrictions on which transplant centers are covered. As a general rule, once patients require supplemental oxygen, transplant evaluation should be initiated because the evaluation process can take some time and generally involves extensive testing that can include heart catheterization, bone density evaluation, colonoscopy, etc.
It does not hurt to start the transplant evaluation too early in patients with IPF but if started too late, there may not be sufficient time to complete the extensive testing before fatal respiratory failure occurs. In general, it is best to check with your transplant center regarding specific policies at that center.
James N Allen, Jr, MD
Clinical Professor of Pulmonary, Allergy, Critical Care & Sleep Medicine
College of Medicine
The Ohio State University