Heart transplantation in selected patients aged 60 years and older: a two-decade retrospective and multicentre analysis.
OBJECTIVE
This study analysed survival and long-term outcomes of heart transplantation in patients aged 60 years and older. We also analysed the impact of a national graft allocation priority [Super Emergency (SE)] and compared survival with younger patients in our centres and in France.


METHODS
We performed a multicentre (University Hospitals in Nantes, Rennes and Tours), 2-decade retrospective study between 1 January 1994 and 31 December 2013. Elderly recipients were placed on the same list as younger patients; the use of marginal donors remained occasional.


RESULTS
A total of 212 patients aged between 60 and 68 years were included. The 1-, 5-, and 10-year survival rates were 83.2%, 77.4% and 63.8%, respectively, which were significantly worse than those of recipients aged <60 years (1-, 5-, and 10-year survival rates of 87.3%, 80.4% and 68.0%, respectively). The postoperative course was acceptable. The main cause of death was malignancy (29.8% in our cohort). Survival was similar between the first and second decades and among the SE group. Our population exhibited better survival than patients <60 years transplanted in France during the same period with 1-, 5-, and 10-year survival rates of 76.8%, 68.0% and 56.3%, respectively. Predictors of survival in the multivariate analysis included ischaemic cardiomyopathy [hazard ratio (HR) 4.1] and postoperative complications, such as dialysis (HR 9.5) and mechanical circulatory support (HR 4.2).


CONCLUSIONS
We report positive postoperative course and long-term outcomes after heart transplantation in older recipients using conventional donors. Our satisfactory outcomes may be explained by the stringent selection of recipients combined with regular follow-up.
Department of Cardiology and CIC-IT 804, CHU Rennes, France.
Christian
C
Bosseau
Department of Cardiac Surgery and Heart Transplantation Unit, CHU Rennes, France.
Bernard
B
Lelong
Department of Cardiology and Heart Transplantation Unit, CHU Nantes, France.
Sabine
S
Pattier
Department of Cardiology and Heart Transplantation Unit, CHU Nantes, France.
Jean-Noël
JN
Trochu
Department of Cardiology and Heart Transplantation Unit, CHU Nantes, France.
Jean-Christian
JC
Roussel
Department of Cardiology and Heart Transplantation Unit, CHRU Tours, France.
Agnès
A
Sirinelli
Department of Cardiology and Heart Transplantation Unit, CHRU Tours, France.
Michel
M
Aupart
Department of Cardiac Surgery and Heart Transplantation Unit, CHU Rennes, France.
Céline
C
Chabanne
French Biomedicine Agency-Agence de la Biomédecine, Saint-Denis, France.
Richard
R
Dorent
French Biomedicine Agency-Agence de la Biomédecine, Saint-Denis, France.
Christelle
C
Cantrelle
Department of Cardiology and CIC-IT 804, CHU Rennes, France.
Philippe
P
Mabo
Department of Cardiology and CIC-IT 804, CHU Rennes, France.
Christophe
C
Leclercq
Department of Cardiac Surgery and Heart Transplantation Unit, CHU Rennes, France.
Jean-Philippe
JP
Verhoye
Department of Cardiac Surgery and Heart Transplantation Unit, CHU Rennes, France.
Erwan
E
Flécher
D000328:Adult; D000368:Aged; D005260:Female; D006333:Heart Failure / Q000601:surgery; D016027:Heart Transplantation / Q000401:mortality / Q000706:statistics & numerical data; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
Elderly; End-stage heart failure; Heart transplantation; Outcomes