Heart transplantation in older candidates

Area of Science:

• Cardiology
• Transplantation Medicine
• Geriatric Medicine

Background:

• Heart transplantation (HTX) recipient profiles are evolving.
• New chronic heart failure therapies have created a cohort of older candidates (61-70 years).
• These older patients may require organs from marginal donors.

Purpose of the Study:

• To evaluate the outcomes of heart transplantation in older recipients (61-70 years) using marginal donors.
• To identify potential negative prognostic factors in this patient group.

Main Methods:

• Retrospective review of 272 heart transplant recipients from May 1994 to December 2005.
• Group 1: 75 patients aged 61-72 years; Group 2: 197 patients aged 18-60 years.
• Comparison of demographics, pre-HTX status, donor characteristics, and outcomes between groups.

Main Results:

• Group 1 patients more frequently received organs from marginal donors (89% vs 29%).
• No significant differences were observed in actuarial survival, perioperative mortality, or rejection rates between groups.
• Freedom from infection, neoplasia, and chronic renal failure also showed no significant differences.

Conclusions:

• Heart transplantation is a viable option for selected older patients (61-70 years) with chronic heart failure.
• Marginal donors can be utilized successfully in older recipients without compromising outcomes.
• Advances in medical therapy have expanded the eligibility criteria for heart transplantation.