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Long-term results of cardiac transplantation in patients older than sixty years. UTAH Cardiac Transplant Program
D A Bull1, S V Karwande, J A Hawkins
1Department of Cardiothoracic Surgery, University of Utah School of Medicine, Salt Lake City, USA.
Insights
Cardiac transplantation in patients over 60 shows fewer rejections but lower survival rates. Careful monitoring for infections and cancers post-transplant is crucial for this age group.
Area of Science:
- Cardiology
- Transplantation Medicine
- Geriatric Medicine
Background:
- Advanced age was historically a contraindication for cardiac transplantation.
- End-stage heart failure patients over 60 were considered if otherwise suitable candidates.
Purpose of the Study:
- To evaluate the outcomes of cardiac transplantation in patients older than 60 years.
- To compare outcomes between older (≥60) and younger (<60) cardiac transplant recipients.
Main Methods:
- Retrospective analysis of 527 cardiac transplantations performed between 1985 and 1994.
- Comparison of rejection episodes, infectious complications, survival rates, and causes of mortality between age groups.
Main Results:
- Patients over 60 experienced significantly fewer rejections (1.9 vs 2.6 per patient, p=0.009).
- No significant difference in infectious complications was observed between groups.
- Short-term and long-term survival were significantly lower for patients over 60 (6-year survival: 54% vs 72%, p<0.05).
- Older recipients had higher mortality from infections and malignancies post-transplant (p<0.05).
Conclusions:
- Cardiac transplantation in patients over 60 warrants caution due to lower survival rates.
- Increased risk of death from infectious complications and malignancies necessitates careful post-transplant surveillance.
- Individualized assessment and close monitoring are essential for elderly transplant candidates.
Abstract:
Advanced age has traditionally been a contraindication to cardiac transplantation. We have, however, offered cardiac transplantation to patients older than 60 years with end-stage heart failure if they were otherwise acceptable candidates. From 1985 to 1994, 527 patients underwent cardiac transplantation. Among these patients, 101 were older than 60 years at transplantation. The mean follow-up of this group is 6 years. Patients older than 60 years had significantly fewer rejection episodes per patient than those who were younger than 60 years at transplantation (1.9 +/- 1.3 vs 2.6 +/- 1.8, p = 0.009). No difference in the number of infectious complications per patient was detected between the two groups. Both short-term and long-term survival after transplantation were significantly lower for patients who were older than 60 years at transplantation than for younger patients (p < 0.05). The 6-year actuarial survival after transplantation for patients older than 60 years was 54% compared with 72% for patients younger than 60 years at transplantation (p < 0.05). Patients older than 60 years at transplantation were more likely to die of infectious complications or malignant disease after transplantation (p < 0.05). We believe caution is warranted in offering cardiac transplantation to patients older than 60 years. This group of patients should be carefully observed for the development of potentially life-threatening infectious complications or new malignant tumors after transplantation.