Differential characteristics of heart transplantation in patients older than 60 years.
BACKGROUND
The effect of advanced age on the results of heart transplantation (HTx) is still controversial. The few articles addressing this issue have not been conclusive, due to either short follow-up periods or small numbers of patients.


METHODS
We present a retrospective study of 560 HTx which were divided into group A, including patients of 60 or less years at HTx (n=465, 83%), and group B, of 95 recipients older than 60 years. A subgroup of the latter, named B1, includes 24 patients older than 65. More than 100 recipient, donor and surgical procedure variables were analyzed for their impact on actuarial survival and incidence of common causes of posttransplant morbidity and mortality during a follow-up period longer than 10 years.


RESULTS
Group B showed a lower number of acute rejection episodes than group A, (1.53+/-1.87 versus 1.96+/-1.81, P<.04). Both groups showed a similar incidence of infection episodes, malignancies or graft vasculopathy, but older patients experienced fewer viral infections than younger ones (9% in group A versus 18% in group B, P<.05). Log-rank test showed a trend to shorter survival in group B (P=.08), a disadvantage that reached significance (P=.01) among patients older than 65 years.


CONCLUSIONS
Patients who were older than 60 at HTx displayed a lower incidence of acute rejection episodes and viral infections, but a trend toward shorter long-term survival. This disadvantage in prognosis was statistically significant among recipients older than 65 years.
Peraira
J R
JR
Hospital Universitario Puerta de Hierro, 28035 Madrid, Spain.
Segovia
J
J
Fuentes
R
R
Ortiz
P
P
Ortigosa
J
J
Silva
L
L
Cañas
A
A
Pulpón
L A
LA
D000206:Actuarial Analysis; D000368:Aged; D000375:Aging; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology; D016027:Heart Transplantation / Q000379:methods* / Q000401:mortality / Q000502:physiology*; D006801:Humans; D015994:Incidence; D007239:Infections / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D015996:Survival Rate; D014652:Vascular Diseases / Q000453:epidemiology