title: Age-associated decline in cardiac allograft rejection.
abstract: The influence of age on cardiac allograft rejection was studied in 57 consecutive recipients. Twenty-one subjects were 54 years of age or older (mean, 57.7 +/- 0.6 years [+/- SEM]; range, 54 to 63 years) and 36 subjects were 52 years of age or younger (mean, 39.9 +/- 1.8 years; range, 16 to 52 years; p less than 0.001). The older recipients had fewer rejection episodes during the first four months following cardiac transplantation (0.24 +/- 0.05 episodes per month versus 0.72 +/- 0.09 episodes per month; p less than 0.001) and during the total duration of follow-up (0.20 +/- 0.03 episodes per month versus 0.40 +/- 0.07 episodes per month; p = 0.045), and experienced their first rejection episode later (50.4 +/- 4.0 days versus 27.7 +/- 8.5 days; p = 0.008). Younger age was found to add significantly as a predictor of rejection in a multivariate analysis that controlled for sex, immunosuppressive agents, cause of heart failure, and pretransplantation lymphocyte cross-match status (r = 0.64, p less than 0.05). Decreased rejection frequency occurred without a concomitant increase in the serious infection rate (67 percent in both groups). The 12-month actuarial survival was 100 percent in the older group and 94 percent in the younger group (p = NS). Decreased rejection in the older recipients is likely a manifestation of an age-associated decline in immune function and might represent an advantage in transplantation for carefully selected older patients.
authors.affiliation: Division of Cardiology, University of Utah Medical Center, Salt Lake City 84132.
authors.forename: D G
authors.initials: DG
authors.lastname: Renlund
authors.forename: E M
authors.initials: EM
authors.lastname: Gilbert
authors.forename: J B
authors.initials: JB
authors.lastname: O'Connell
authors.forename: W A
authors.initials: WA
authors.lastname: Gay
authors.forename: K W
authors.initials: KW
authors.lastname: Jones
authors.forename: N A
authors.initials: NA
authors.lastname: Burton
authors.forename: D B
authors.initials: DB
authors.lastname: Doty
authors.forename: S V
authors.initials: SV
authors.lastname: Karwande
authors.forename: C W
authors.initials: CW
authors.lastname: Dewitt
authors.forename: R L
authors.initials: RL
authors.lastname: Menlove
authors.forename: C M
authors.initials: CM
authors.lastname: Herrick
authors.forename: M R
authors.initials: MR
authors.lastname: Bristow
mesh_terms: D000206:Actuarial Analysis; D000293:Adolescent; D000328:Adult; D000375:Aging / Q000276:immunology*; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D016027:Heart Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D013223:Statistics as Topic; D013997:Time Factors
chemical_list: D007166:Immunosuppressive Agents