Age-associated decline in cardiac allograft rejection.
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.
Renlund
D G
DG
Division of Cardiology, University of Utah Medical Center, Salt Lake City 84132.
Gilbert
E M
EM
O'Connell
J B
JB
Gay
W A
WA
Jones
K W
KW
Burton
N A
NA
Doty
D B
DB
Karwande
S V
SV
Dewitt
C W
CW
Menlove
R L
RL
Herrick
C M
CM
Bristow
M R
MR
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
D007166:Immunosuppressive Agents