Cardiac transplantation in the older recipient: excellent long-term survival based on pretransplant screening.
BACKGROUND
Cardiac transplantation has become the established treatment of choice for eligible patients with end-stage congestive heart failure. Older recipients (over the age of 60) are sometimes regarded as too high risk for transplant. Because chronological age is frequently disparate from physiologic age, we hypothesized that with careful selection after a comprehensive screening evaluation we would be able to achieve comparable survival and quality of life in an older population.


METHODS
Between January 1989 and December 2002, 240 de novo adult cardiac transplants were performed for 74 female and 176 male patients. Prior to listing for cardiac transplantation, the patients were evaluated to exclude significant comorbidities that would limit survival or functional capacity postsurgery. In patients over the age of 60, particularly rigorous testing was conducted to eliminate significant extracardiac disease.


RESULTS
The patients are divided in this analysis into three groups based on age at transplant (age 18 to 45, 46 to 59, and 60 years or older). Older recipients experienced similar rates of moderately severe cellular rejection (ISHLT grade 3A/ B). Survival as derived by Kaplan-Meier analysis was equivalent for all groups by Mantel-Cox logrank test (P = NS). The survival for patients older than age 60 was 83.1%, 73.7%, 67.7%, 57.4%, and 43.1% at 1,3, 5, 7, and 10 years posttransplant, respectively.


CONCLUSIONS
We conclude that chronological age over 60 years old should not exclude a patient from the potential long-term benefit of cardiac transplant, ensuring added longevity and excellent quality of life.
Baran
D A
DA
Zena and Michael A. Weiner Cardiovascular Institute, Mt. Sinai Medical Center, New York, NY 10029, USA. David.Baran@mssm.edu
Galin
I D
ID
Courtney
M C
MC
Correa
R
R
Chan
M
M
Spielvogel
D
D
Lansman
S L
SL
Gass
A L
AL
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001706:Biopsy; D005260:Female; D006333:Heart Failure / Q000601:surgery; D016027:Heart Transplantation / Q000276:immunology / Q000401:mortality / Q000706:statistics & numerical data*; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012189:Retrospective Studies; D016019:Survival Analysis; D017741:Survivors