397. Infectious Complications and Outcome of Lung Transplantation (LT) in Elderly Patients Receiving Alemtuzumab
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: A recent review of UNOS database concluded that LT should be used with caution in patients (pts) > 60 years, and not be used in pts > 70 years. At our center, 47% of LT pts were > 60 years. Most pts received induction with alemtuzumab, which causes profound and durable T-cell depletion.
Methods: We retrospectively reviewed our experience with 121 pts ≥ 60 years undergoing LT from January 2006-June 2008. Infections were defined by CDC and EORTC criteria.
Results: 36% were 60-65 (“< 65”), 38% were 66-70 and 26% were 71-83 years. Underlying lung diseases included IPF (43%), COPD (43%) and others (14%). Pts 65. During the first 3 months, the rates of major bacterial infections did not differ between the groups. After 3 months, pts 65 years (43% vs. 23%; p<.05). In pts < 65, these bacterial infections coincided with the period of rejection. There was no difference in the rate of viral or fungal infections. There was a higher incidence of drug toxicity (15% vs. 2%; p< 0.0001) and malignancy (15% vs. 0; p= 0.008) in pts > 65 years. Uni- and multivariate analyses identified coronary artery disease (p= 0.03), CMV mismatch (p= 0.002) and major infection (p= 0.001) as factors associated with mortality. There was no difference in survival and rejection rates between the 3 groups at 1 and 3 months, and 1 and 3 years.
Conclusions: Bacterial infection is the leading killer of LT pts > 60 years. Immune senescence in older LT pts might lower resistance to major bacterial infections and post-LT cancers. The higher rate of drug toxicity in patients > 65 years emphasizes the need for well-designed PK/PD studies for immunosuppressive agents and other drugs in this age group.
C Clancy, MD, UPitt, Pittsburgh, PA, M. Hong Nguyen, MD, UPMC, Pittsburgh, PA, Aniket Vadnerkar, MD, Pittsburgh University, Pittsburgh, PA and  A. Vadnerkar,
NIH T32 grant Role(s): Other, Research fellow.
C. J. Clancy, None..
M. H. Nguyen, None.