Lung transplantation in the older adult

The first long-term, successful, human-isolated lung transplant was performed in 1983 by the Toronto Lung Transplant Group. Two and a half decades have passed since this landmark procedure and almost 19,000 lung transplants have been performed. At present, lung transplantation is the preferred treatment option for a variety of end-stage pulmonary diseases. Remarkable progress has occurred through refinement in technique and improved understanding of transplant immunology and microbiology. Elderly lung transplant recipients usually undergo transplantation for chronic obstructive pulmonary disease or idiopathic pulmonary fibrosis and face unique challenges. It is increasingly evident that 'biologic age' is more important than actual recipient age. Postoperative immunosuppression regimens and education require greater individualization in elderly adults owing to the increased risk for infection and greater risk involved with complications. A multidiscipliniary approach to lung transplantation, especially in the older adult, requires an in-depth knowledge of transplant-related issues, an awareness of geriatric issues, and access to decision and educational support.