Cardiac transplantation for older patients: Characteristics and outcomes in the septuagenarian population

• Published in: The Journal of heart and lung transplantation Vol. 35; no. 3; pp. 362 - 369
• Main Authors: Cooper, Lauren B., MD, Lu, Di, MS, Mentz, Robert J., MD, Rogers, Joseph G., MD, Milano, Carmelo A., MD, Felker, G. Michael, MD, MHS, Hernandez, Adrian F., MD, MHS, Patel, Chetan B., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2016
• Subjects: Adolescent; Adult; Age Factors; Aged; aging; Cohort Studies; Female; Heart Transplantation; Humans; Male; Middle Aged; organ donor; organ recipient; Retrospective Studies; septuagenarian; Surgery; Treatment Outcome; Young Adult; organ recipient; organ donor; aging; septuagenarian; heart transplantation
• ISSN: 1053-2498; 1557-3117
• DOI: 10.1016/j.healun.2015.10.028

Background With increasing age of patients with heart failure, it is important to understand the potential role for orthotopic heart transplant (OHT) in elderly patients. We examined recipient and donor characteristics and long-term outcomes of older recipients of OHT in the United States. Methods Using the United Network for Organ Sharing database, we identified OHT recipients from the years 1987–2014 and stratified them by age 18–59 years old, 60–69 years old, and ≥70 years old. We compared baseline characteristics of recipients and donors and assessed outcomes across groups. Results During this period, 50,432 patients underwent OHT; 71.8% ( n = 36,190) were 18–59 years old, 26.8% ( n = 13,527) were 60–69 years old, and 1.4% ( n = 715) were ≥70 years old. Comparing the ≥70 years old group and 60–69 years old group, older patients had higher rates of ischemic etiology (53.6% vs 44.9%) and baseline renal dysfunction (61.4% vs 56.4%) and at the time of OHT were less likely to be currently hospitalized (45.0% vs 50.9%) or supported with left ventricular assist device therapy (21.0% vs 28.3%). Older recipients received organs from older donors (median age 36 years old vs 30 years old) who were more likely to have diabetes and substance use. After OHT, the median length of stay was similar between groups. At 1 year, of patients alive, patients ≥70 years old had fewer rejection episodes (17.8%) compared with patients 60–69 years old (29.5%). The 5-year mortality was 26.9% for recipients 18–59 years old, 29.3% for recipients 60–69 years old, and 30.8% for recipients ≥70 years old. Conclusions Despite advanced age and less ideal donors, OHT recipients in their 70s had similar outcomes to recipients in their 60s. Selected older patients should not routinely be excluded from consideration for OHT.