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Cardiac transplantation in patients over 60 years of age
O H Frazier1, M P Macris, J M Duncan
1Division of Cardiovascular Surgery, Texas Heart Institute, Houston 77225.
Insights
Older adults can safely undergo heart transplantation. This study found that patients over 60 had similar or better outcomes than younger recipients, challenging age as a contraindication for cardiac transplant.
Area of Science:
- Cardiology
- Transplantation Surgery
- Geriatric Medicine
Background:
- Traditional cardiac transplant programs excluded patients over 55.
- Age was a common contraindication for heart transplantation.
- The Texas Heart Institute re-evaluated this age-based exclusion policy.
Purpose of the Study:
- To assess the outcomes of cardiac transplantation in patients over 60 years of age.
- To determine if advanced age is a significant contraindication for heart transplant.
- To compare outcomes in older versus younger heart transplant recipients.
Main Methods:
- Retrospective analysis of 200 cardiac transplants performed between July 1982 and August 1987.
- Focus on 28 patients (14%) aged over 60 at the time of transplant.
- Immunosuppression primarily with cyclosporine and prednisone, with azathioprine added in 1985.
Main Results:
- Incidences of rejection (1.2 vs. 1.7 episodes/patient) and infection (1.4 vs. 1.3 episodes/patient) were comparable between patients over 60 and those under 60.
- 23 out of 28 older patients (82%) were alive and well at the time of reporting.
- One-year actuarial survival for patients over 60 was 83%, compared to 75% for younger patients.
Conclusions:
- Cardiac transplantation is a viable option for patients over 60 years of age.
- Outcomes in older heart transplant recipients are comparable, and potentially better, than in younger patients.
- Advanced age should not be considered a major contraindication for cardiac transplantation.
Abstract:
Cardiac transplant programs have routinely excluded patients over 55 years of age from consideration as transplant candidates. The Texas Heart Institute modified this policy of using age as a contraindication to transplantation. Between July, 1982, and August, 1987, a total of 200 cardiac transplants were performed, 28 (14%) of which were in patients over 60 years of age, the eldest being 66 years old at the time of transplant. Our immunosuppressive regimen consisted primarily of cyclosporine and prednisone. In 1985, azathioprine was added in an effort to decrease dosages of cyclosporine, thereby decreasing its associated nephrotoxicity. The incidences of rejection and infection were 1.2 and 1.4 episodes/patient, respectively, for those over 60 years of age versus 1.7 and 1.3 episodes/patient, respectively, for those less than 60 years of age. Of the 28 patients, 23 are alive and well. Four deaths were caused by infection, and the other by diffuse coronary arteritis. The one-year actuarial survival for patients over 60 years of age was 83%, compared with 75% for the other transplant patients. We conclude that persons over 60 years of age can undergo cardiac transplantation with results equal to or perhaps better than those of other heart transplant patients. Our experience suggests that advanced age should not be considered a major contraindication to cardiac transplantation.