Long-term results of heart transplantation in patients older than 60 years.
BACKGROUND
Advanced age has been traditionally considered a relative contraindication for heart transplantation. Older patients are now considered as potential candidates for heart transplantation. The objective of this study was to evaluate the long-term results of heart transplantation in patients older than 60 years.


METHODS
Between 1986 and 2001, 81 patients aged between 60 and 70 years (mean, 63 +/- 2 years) underwent heart transplantation. These patients were compared with 403 adult recipients younger than 60 years (mean, 47 +/- 11 years) who underwent transplantation during the same period.


RESULTS
Thirty-day mortality was 6% (5/81) and 6% (25/403) in the older and younger patients, respectively (P = NS). Actuarial survival at 1, 5, and 10 years was 88% +/- 4% versus 83% +/- 2%, 75% +/- 5% versus 69% +/- 2%, and 50% +/- 9% versus 51% +/- 3% in the older and younger patients, respectively (P = NS). Older patients had significantly fewer rejection episodes (P =.003). Freedom from allograft coronary artery disease at 1, 5, and 10 years was 98% +/- 2% versus 92% +/- 2%, 85% +/- 6% versus 76% +/- 3%, and 81% +/- 7% versus 68% +/- 3% (P =.1). The incidences of infectious complication, cytomegalovirus infection, and posttransplant lymphoproliferative disorder were similar between the 2 groups, but older recipients were more likely to have a nonposttransplant lymphoproliferative disorder cancer (P =.002). Age at transplantation was not identified as an independent risk factor for early and late death.


CONCLUSIONS
Heart transplantation in selected patients aged 60 years and older results in survival comparable with that of younger patients. Older patients have a lower risk of rejection but an increased risk of development of a nonposttransplant lymphoproliferative disorder cancer. Advanced age per se should not be considered as an exclusion criterion for transplantation.
Demers
Philippe
P
Department of Cardiothoracic Surgery, Stanford University School of Medicine, CA 94305-5247, USA.
Moffatt
Susan
S
Oyer
Philip E
PE
Hunt
Sharon A
SA
Reitz
Bruce A
BA
Robbins
Robert C
RC
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002140:California / Q000453:epidemiology; D009202:Cardiomyopathies / Q000453:epidemiology / Q000601:surgery; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology / Q000209:etiology; D016027:Heart Transplantation / Q000401:mortality; D006801:Humans; D007902:Length of Stay; D008232:Lymphoproliferative Disorders / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000453:epidemiology / Q000601:surgery; D009369:Neoplasms / Q000453:epidemiology / Q000209:etiology; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000209:etiology; D016019:Survival Analysis; D013995:Time; D013997:Time Factors; D016896:Treatment Outcome