title: Factors associated with 5-year survival in older heart transplant recipients.
abstract: OBJECTIVE
  The aim of the present study was to identify the predictors of 5-year survival in elderly patients undergoing orthotopic heart transplantation (OHT).
  
  
  METHODS
  A review of the United Network for Organ Sharing database was conducted of recipients 60 years old or older undergoing OHT from 1995 to 2004. The variables were compared between the 5-year survivors and the patients who died within 5 years of OHT. A multivariate logistic regression model was constructed using the covariates significantly associated with 5-year survival on univariate analysis.
  
  
  RESULTS
  A total of 5330 elderly patients underwent OHT during the study period. Of these patients, 3492 (65.5%) were 5-year survivors, 1580 (29.6%) had died within 5 years of OHT and were considered controls, and 258 (4.8%) were lost to follow-up. The predictors of improved 5-year survival included younger age (odds ratio [OR], 0.97; 95% confidence interval [CI], 0.95-1.00; P = .03), lower creatinine (OR, 0.92; 95% CI, 0.87-0.98; P = .01), white race (OR, 1.23; 95% CI, 1.02-1.49; P = .03), shorter ischemic time (OR, 0.93; 95% CI, 0.87-0.99; P = .02), and younger donor age (OR, 0.99; 95% CI, 0.99-1.00; P = .03). The following significantly reduced the odds of surviving to 5 years: mechanical ventilation (OR, 0.48; 95% CI, 0.33-0.71; P < .001), hypertension (OR, 0.79; 95% CI, 0.69-0.91; P = .001), and diabetes (OR, 0.79; 95% CI, 0.67-0.92; P = .003). Ventricular assist device data were only available for 2538 patients (49.6%). When added to the multivariate model, the use of a ventricular assist device significantly reduced the odds of surviving 5 years after OHT (OR, 0.63; 95% CI, 0.50-0.81; P < .001).
  
  
  CONCLUSIONS
  In the present study of more than 5000 elderly OHT patients, younger recipient age, white race, lower creatinine, younger donor age, and shorter ischemic time were associated with improved 5-year survival. In contrast, bridging with a ventricular assist device, mechanical ventilation, hypertension, and diabetes significantly decreased the odds of 5-year survival. These findings might be useful for prognostication in this higher risk patient population.
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA.
authors.forename: Arman
authors.initials: A
authors.lastname: Kilic
authors.forename: Eric S
authors.initials: ES
authors.lastname: Weiss
authors.forename: David D
authors.initials: DD
authors.lastname: Yuh
authors.forename: Ashish S
authors.initials: AS
authors.lastname: Shah
authors.forename: John V
authors.initials: JV
authors.lastname: Conte
mesh_terms: D000367:Age Factors; D000368:Aged; D016022:Case-Control Studies; D019992:Databases as Topic; D016027:Heart Transplantation / Q000009:adverse effects / Q000401:mortality*; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D013997:Time Factors; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome; D014481:United States