title: Long-term outcomes of heart transplantation in older recipients.
abstract: BACKGROUND
  Heart transplantation in the elderly is increasingly common. In the mid-1990s, 25% of recipients in our program were >62 years of age. We evaluated outcomes from one institution with the hypothesis that older recipients may be at higher risk of major complications associated with immunosuppression.
  
  
  METHODS
  We analyzed results for 182 patients aged 62 to 75 years (mean +/- SD: 66.3 +/- 11.4 years) who underwent heart transplantation between January 1995 and July 2001 at a single institution. They were compared with a control group of 348 contemporaneous adult recipients aged 18 to 62 years (mean +/- SD: 48.2 +/- 11.4 years). All recipients in this consecutive cohort had a follow-up of at least at least 5 years. End-points studied were Kaplan-Meier survival, freedom from dialysis and freedom from malignancy at 100 months. Follow-up was 100% at 100 months.
  
  
  RESULTS
  At 100 months, survival for the elderly was 55% (46 remaining at risk) and 63% (102 remaining at risk) for controls (p = 0.051, log-rank test). Re-transplant and dialysis, but not recipient age or malignancy, were predictive of survival by regression analysis (p = 0.003, p < 0.001, p = 0.53 and p = 0.84, respectively). Freedom from malignancy at 100 months was 68% for the elderly and 95% for controls (p < 0.001). Age predicted malignancy by regression analysis (p < 0.001). At 100 months, freedom from dialysis was 81% for the elderly and 87% for controls (p = 0.005). Pre-operative creatinine, but not age, was predictive of need for dialysis (p = 0.003 and p = 0.47, respectively).
  
  
  CONCLUSIONS
  Although long-term survival of older heart transplant recipients is acceptable, it is significantly lower than in young recipients. The increased risk of renal failure and malignancy among elderly patients likely influences the difference in survival observed between the two groups. Pre-operative renal function warrants careful consideration. As ventricular assist device technology improves, it may be used to complement heart transplantation to avoid immunosuppression and its side effect of malignancy in older patients with advanced heart failure.
authors.affiliation: David Geffen School of Medicine, Heart Transplant Program, University of California, Los Angeles, Los Angeles, California, USA. danielmarelli@gmail.com
authors.forename: Daniel
authors.initials: D
authors.lastname: Marelli
authors.forename: Jon
authors.initials: J
authors.lastname: Kobashigawa
authors.forename: Michele A
authors.initials: MA
authors.lastname: Hamilton
authors.forename: Jaime D
authors.initials: JD
authors.lastname: Moriguchi
authors.forename: Reza
authors.initials: R
authors.lastname: Kermani
authors.forename: Abbas
authors.initials: A
authors.lastname: Ardehali
authors.forename: Jignesh
authors.initials: J
authors.lastname: Patel
authors.forename: Emily
authors.initials: E
authors.lastname: Noguchi
authors.forename: Ramin
authors.initials: R
authors.lastname: Beygui
authors.forename: Hillel
authors.initials: H
authors.lastname: Laks
authors.forename: Mark
authors.initials: M
authors.lastname: Plunkett
authors.forename: Richard
authors.initials: R
authors.lastname: Shemin
authors.forename: Fardad
authors.initials: F
authors.lastname: Esmailian
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D016027:Heart Transplantation / Q000401:mortality*; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome