title: Outcomes of cardiac transplantation in septuagenarians.
abstract: BACKGROUND
  Cardiac transplantation in many centers is programmatically limited to patients aged younger than 70 years. We investigated the trends and outcomes for cardiac transplantation in recipients aged 70 years and older in the United States.
  
  
  METHODS
  De-identified data were provided by United Network of Organ Sharing. Transplant recipients were grouped by age 60-69 years and 70 years and older. Univariate comparisons were performed using Student's t-test or the Pearson chi-square test. Survival was estimated using the Kaplan-Meier technique and compared with the log-rank test. Cox regression was used to determine predictors of death after transplant. Statistical significance was assigned to p < 0.05.
  
  
  RESULTS
  Between January 1, 1998, and June 15, 2010, 5,807 sexagenarians and 332 septuagenarians received allografts. The septuagenarian cohort had more men, less diabetes, was less likely to have a ventricular assist device, and more likely to be status II. Donors for septuagenarians were older and died more frequently from intracranial hemorrhage. Median unadjusted survival was 9.8 years for sexagenarians vs 8.5 years for septuagenarians (p = 0.003). There was no difference in the incidence of cerebrovascular accident, length of stay, or pacemaker need between groups. Septuagenarians were less likely to be treated for rejection the first year (p = 0.001). Age was a multivariate predictor of death (hazard ratio, 1.289; 95% confidence interval, 1.039-1.6; p = 0.021).
  
  
  CONCLUSIONS
  Selected septuagenarians with advanced heart failure can derive great benefit from cardiac transplantation, although survival is inferior to that of an immediately younger sexagenarian cohort. Most of the mortality risk is seen in the first year after transplantation. A reduced incidence of rejection was observed and warrants further study.
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Montefiore-Einstein Heart Center, Bronx, New York, USA. dgoldste@montefiore.org
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Goldstein
authors.forename: Ricardo
authors.initials: R
authors.lastname: Bello
authors.forename: Jooyoung J
authors.initials: JJ
authors.lastname: Shin
authors.forename: Gerin
authors.initials: G
authors.lastname: Stevens
authors.forename: Ronald
authors.initials: R
authors.lastname: Zolty
authors.forename: Simon
authors.initials: S
authors.lastname: Maybaum
authors.forename: David
authors.initials: D
authors.lastname: D'Alessandro
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology; D006333:Heart Failure / Q000453:epidemiology / Q000601:surgery*; D016027:Heart Transplantation / Q000401:mortality*; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000639:trends*; D012189:Retrospective Studies; D015996:Survival Rate; D014180:Transplantation; D014481:United States / Q000453:epidemiology