Age and heart transplantation: results from a heart failure management unit.
BACKGROUND
More evidence is needed to assess the pros and cons of maintaining age-limit policies in heart transplantation (HT).


METHODS
We analyzed clinical data from a heart failure management unit to investigate the impact of age on prognosis of two distinct cohorts: (i) 309 patients (median age, 57 yr; 62% male) with severe chronic heart failure (CHF) consecutively screened for HT; (ii) 336 HT recipients (median age 56 yr, 82% male).


RESULTS
In CHF patients (screened for HT), prognosis was conditioned by the underlying severity of cardiac disease (i.e., New York Heart Association class III-IV, decreasing blood pressure, presence of atrial fibrillation and severe mitral regurgitation), whereas increasing age showed no sign of predicting all-cause or cardiovascular mortality (both p > or = 0.4). In HT recipients, age did not retain significance at multivariate analysis as an independent predictor (p > or = 0.14 for both all-cause and cardiovascular death), whereas ischemic etiology of pre-existing CHF did (p < or = 0.02).


CONCLUSIONS
Age did not appear to be a primary determinant of all-cause or cardiovascular mortality among potential HT candidates or eventual recipients (ischemic etiology of CHF turned out to be the major determinant of post-transplant outcome). These results support the concept that HT may be considered a treatment option in patients with more advanced age strata, particularly when affected by non-ischemic cardiomyopathy.
Grigioni
Francesco
F
Cardiovascular Department, The University of Bologna, Bologna, Italy. francesco.grigioni@unibo.it
Potena
Luciano
L
Barbieri
Andrea
A
Bianchi
Giorgio
G
Reggianini
Letizia
L
Russo
Antonio
A
Fallani
Francesco
F
Magnani
Gaia
G
Coccolo
Fabio
F
Arpesella
Giorgio
G
Rapezzi
Claudio
C
Modena
Maria Grazia
MG
Branzi
Angelo
A
D000328:Adult; D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000401:mortality* / Q000601:surgery*; D016027:Heart Transplantation / Q000401:mortality*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications / Q000401:mortality; D011379:Prognosis; D012189:Retrospective Studies