Elsevier

Transplantation Proceedings

Volume 43, Issue 10, December 2011, Pages 3851-3856
Transplantation Proceedings

Thoracic transplantation
Cardiac: Outcome
Heart Transplantation in Patients Aged 70 Years and Older: A Two-Decade Experience

https://doi.org/10.1016/j.transproceed.2011.08.086Get rights and content

Abstract

Objective

Advanced age has been viewed as a contraindication to orthotopic heart transplantation (OHT). We analyzed the outcome of OHT in patients who were aged 70 years or older and compared the results with those in younger patients during a two-decade period.

Methods

A total of 519 patients underwent first-time single-organ OHT at our institution from 1988 to 2009. Patients were divided into three groups by age: ≥ 70-years old (group 1, n = 37), 60 to 69-years old (group 2, n = 206), and ≤60-years old (group 3, n = 276). Primary endpoints were 30-days, and 1-, 5-, and 10-years survival. Secondary outcomes included re-operation for bleeding, postoperative need for dialysis, and length of postoperative intubation.

Results

There was no significant difference in survival between the greater than or equal to 70-year-old group and the two younger age groups for the first 10 years after OHT. Survival rates at 30 days, and 1-, 5-, and 10-years, and median survival in group 1 recipients were 100%, 94.6%, 83.2%, 51.7%, and 10.9 years (CI 7.1–11.0), respectively; in group 2 those numbers were 97.6%, 92.7%, 73.8%, 47.7%, and 9.1 years (CI 6.7–10.9), respectively; and in group 3 those numbers were 96.4%, 92.0%, 74.7%, 57.1%, and 12.2 years (CI 10.7–15.4; P = NS), respectively. There was no significant difference in secondary outcomes of re-operation for bleeding, postoperative need for dialysis, and prolonged intubation among the three age groups.

Conclusions

Patients who are aged 70 years and older can undergo heart transplantation with similar morbidity and mortality when compared with younger recipients. Advanced heart failure patients who are aged 70 years and older should not be excluded from transplant consideration based solely on an age criterion. Stringent patient selection, however, is necessary.

Section snippets

Patients and Methods

Consecutive recipients of single-organ OHT performed at Cedars-Sinai Medical Center from December 1988 to December 2009 were reviewed. Recipients were divided into three groups based on age at transplant: ≥ 70-years old (group 1), 60- to 69-years old (group 2), and < 60-years old (group 3). Primary endpoints were 30 days and 1-, 5-, and 10-years survival, respectively. Secondary outcomes included re-operation for bleeding, postoperative need for dialysis, and postoperative intubation and

Results

We reviewed 519 consecutive first-time single-organ OHTs at Cedars-Sinai Medical Center from December 1988 through December 2009. The mean age was 48.5 ± 10.0 years (range, 14.8 years to 59.9 years) in the youngest group, 64.9 ± 2.8 years (range, 60.0 years to 69.8 years) in patients 60- to 69-years old, and 73.3 ± 2.1 years (range, 70.0 years to 77.7 years) in the oldest age group. Preoperative patient characteristics and donor characteristics by age groups are listed in Table 1 and Table 2,

Discussion

This study describes the largest cohort of OHT recipients to date who were ≥70 years old of age at the time of transplant, and reveals similar morbidity and mortality when compared with younger recipients. Thirty-day (operative) survival, along with 10-year survival after heart transplantation in the oldest age group was similar to recipients between 60 and 69 years of age and those ≤60-years old. The main criticism of OHT in elderly patients has been that they may not have the same duration of

Conclusion

The findings in this study comparing septuagenarians to younger OHT recipients reveal that advanced age should not be a contraindication for heart transplantation. As life expectancy continues to increase, it will be necessary to continually redefine what is considered elderly. At the current time, there are no guidelines on the upper age limit for OHT, but this study shows promising results for those patients who are ≥70 years of age. Although there is a growing gap between cardiac organ

References (40)

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