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DOI: 10.1055/s-0034-1393959
Heart Transplantation in Patients Older than 65 Years: Worthwhile or Wastage of Organs?
Publikationsverlauf
27. Mai 2014
04. Juli 2014
Publikationsdatum:
21. November 2014 (online)
![](https://www.thieme-connect.de/media/thoracic/201508/lookinside/thumbnails/10-1055-s-0034-1393959_143725oc-1.jpg)
Abstract
Background Patients older than 65 years have traditionally not been considered candidates for heart transplantation. However, recent studies have shown similar survival. We evaluated immediate and medium-term results in patients older than 65 years compared with younger patients.
Methods From November 2003 to December 2013, 258 patients underwent transplantation. Children and patients with other organ transplantations were excluded from this study. Recipients were divided into two groups: 45 patients (18%) aged 65 years and older (Group A) and 203 patients (81%) younger than 65 years (Group B).
Results Patients differed in age (67.0 ± 2.2 vs. 51.5 ± 9.7 years), but gender (male 77.8 vs. 77.3%; p = 0.949) was similar. Patients in Group A had more cardiovascular risk factors and ischemic cardiomyopathy (60 vs. 33.5%; p < 0.001). Donors to Group A were older (38.5 ± 11.3 vs. 34.0 ± 11.0 years; p = 0.014). Hospital mortality was 0 vs. 5.9% (p = 0.095) and 1- and 5-year survival were 88.8 ± 4.7 versus 86.8 ± 2.4% and 81.5 ± 5.9 versus 77.2 ± 3.2%, respectively. Mean follow-up was 3.8 ± 2.7 versus 4.5 ± 3.1 years. Incidence of cellular/humoral rejection was similar, but incidence of cardiac allograft vasculopathy was higher (15.6 vs. 7.4%; p = 0.081). Incidence of diabetes de novo was similar (p = 0.632), but older patients had more serious infections in the 1st year (p = 0.018).
Conclusion Heart transplantation in selected older patients can be performed with survival similar to younger patients, hence should not be restricted arbitrarily. Incidence of infections, graft vascular disease, and malignancies can be reduced with a more personalized approach to immunosuppression. Allocation of donors to these patients does not appear to reduce the possibility of transplanting younger patients.
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References
- 1 McMurray JJ, Adamopoulos S, Anker SD , et al; ESC Committee for Practice Guidelines. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J 2012; 33 (14) 1787-1847
- 2 Mehra MR, Kobashigawa J, Starling R , et al. Listing criteria for heart transplantation: International Society for Heart and Lung Transplantation guidelines for the care of cardiac transplant candidates—2006. J Heart Lung Transplant 2006; 25 (9) 1024-1042
- 3 Lund LH, Edwards LB, Kucheryavaya AY , et al; International Society for Heart and Lung Transplantation. The Registry of the International Society for Heart and Lung Transplantation: Thirtieth Official Adult Heart Transplant Report—2013; focus theme: age. J Heart Lung Transplant 2013; 32 (10) 951-964
- 4 Prieto D, Antunes P, Antunes MJ. Donor mitral valve repair in cardiac transplantation. Transplant Proc 2009; 41 (3) 932-934
- 5 Stewart S, Winters GL, Fishbein MC , et al. Revision of the 1990 working formulation for the standardization of nomenclature in the diagnosis of heart rejection. J Heart Lung Transplant 2005; 24 (11) 1710-1720
- 6 Mehra MR, Crespo-Leiro MG, Dipchand A , et al. International Society for Heart and Lung Transplantation working formulation of a standardized nomenclature for cardiac allograft vasculopathy-2010. J Heart Lung Transplant 2010; 29 (7) 717-727
- 7 Weiss ES, Allen JG, Arnaoutakis GJ , et al. Creation of a quantitative recipient risk index for mortality prediction after cardiac transplantation (IMPACT). Ann Thorac Surg 2011; 92 (3) 914-921 , discussion 921–922
- 8 Hong KN, Iribarne A, Worku B , et al. Who is the high-risk recipient? Predicting mortality after heart transplant using pretransplant donor and recipient risk factors. Ann Thorac Surg 2011; 92 (2) 520-527 , discussion 527
- 9 Daneshvar D, Czer LS, Phan A , et al. Heart transplantation in patients aged 70 years and older: a two-decade experience. Transplant Proc 2011; 43 (10) 3851-3856
- 10 Colvin-Adams M, Smithy JM, Heubner BM , et al. OPTN/SRTR 2012 Annual Data Report: heart. Am J Transplant 2014; 14 (1) (Suppl. 01) 113-138
- 11 Eurotransplant Annual Report 2012 (April 2013) . Available online at www.eurotransplant.org . Accessed on April 16, 2014
- 12 Ditchfield JA, Granger E, Spratt P , et al. Aortic valve replacement in octogenarians. Heart Lung Circ 2014; : (e-pub ahead of print)
- 13 Sumi M, Ariyoshi T, Miura T , et al. Are octogenarians in good condition after cardiac valvular surgery?. Ann Thorac Cardiovasc Surg 2014; (e-pub ahead of print)
- 14 Goldstein DJ, Bello R, Shin JJ , et al. Outcomes of cardiac transplantation in septuagenarians. J Heart Lung Transplant 2012; 31 (7) 679-685
- 15 Morgan JA, John R, Weinberg AD , et al. Long-term results of cardiac transplantation in patients 65 years of age and older: a comparative analysis. Ann Thorac Surg 2003; 76 (6) 1982-1987
- 16 Blanche C, Blanche DA, Kearney B , et al. Heart transplantation in patients seventy years of age and older: a comparative analysis of outcome. J Thorac Cardiovasc Surg 2001; 121 (3) 532-541
- 17 Hakim FT, Gress RE. Immunosenescence: deficits in adaptive immunity in the elderly. Tissue Antigens 2007; 70 (3) 179-189
- 18 Fulop T, Kotb R, Fortin CF, Pawelec G, de Angelis F, Larbi A. Potential role of immunosenescence in cancer development. Ann N Y Acad Sci 2010; 1197: 158-165
- 19 Malaguarnera L, Cristaldi E, Malaguarnera M. The role of immunity in elderly cancer. Crit Rev Oncol Hematol 2010; 74 (1) 40-60
- 20 Hakim FT, Gress RE. Immunosenescence: immune deficits in the elderly and therapeutic strategies to enhance immune competence. Expert Rev Clin Immunol 2005; 1 (3) 443-458
- 21 Lindelöw B, Bergh CH, Herlitz H, Waagstein F. Predictors and evolution of renal function during 9 years following heart transplantation. J Am Soc Nephrol 2000; 11 (5) 951-957
- 22 Ojo AO, Held PJ, Port FK , et al. Chronic renal failure after transplantation of a nonrenal organ. N Engl J Med 2003; 349 (10) 931-940
- 23 Arnaoutakis GJ, George TJ, Allen JG , et al. Institutional volume and the effect of recipient risk on short-term mortality after orthotopic heart transplant. J Thorac Cardiovasc Surg 2012; 143 (1) 157-167 , e1
- 24 Weiss ES, Meguid RA, Patel ND , et al. Increased mortality at low-volume orthotopic heart transplantation centers: should current standards change?. Ann Thorac Surg 2008; 86 (4) 1250-1259 , discussion 1259–1260
- 25 Lietz K, John R, Mancini DM, Edwards NM. Outcomes in cardiac transplant recipients using allografts from older donors versus mortality on the transplant waiting list; implications for donor selection criteria. J Am Coll Cardiol 2004; 43 (9) 1553-1561
-
References
- 1 Prieto D, Correia P, Batista M, Antunes M. Heart transplantation in patients over 65 years of age. Worthwhile or wastage of organs?. Thorac Cardiovasc Surg 2014;
- 2 Weiss ES, Allen JG, Arnaoutakis GJ , et al. Creation of a quantitative recipient risk index for mortality prediction after cardiac transplantation (IMPACT). Ann Thorac Surg 2011; 92 (3) 914-921 , discussion 921–922
- 3 Kilic A, Weiss ES, George TJ , et al. What predicts long-term survival after heart transplantation? An analysis of 9,400 ten-year survivors. Ann Thorac Surg 2012; 93 (3) 699-704
- 4 George TJ, Kilic A, Beaty CA, Conte JV, Mandal K, Shah AS. Septuagenarians bridged to heart transplantation with a ventricular assist device have outcomes similar to younger patients. Ann Thorac Surg 2013; 95 (4) 1251-1260 , discussion 1260–1261
- 5 Daneshvar D, Czer LSC, Phan A , et al. Heart transplantation in patients aged 70 years and older: a two-decade experience. Transplant Proc 2011; 43 (10) 3851-3856
- 6 Lund LH, Edwards LB, Kucheryavaya AY , et al; International Society for Heart and Lung Transplantation. The Registry of the International Society for Heart and Lung Transplantation: Thirtieth Official Adult Heart Transplant Report—2013; focus theme: age. J Heart Lung Transplant 2013; 32 (10) 951-964
- 7 Tjang YS, van der Heijden GJMG, Tenderich G, Körfer R, Grobbee DE. Impact of recipient's age on heart transplantation outcome. Ann Thorac Surg 2008; 85 (6) 2051-2055
- 8 Favaloro R, Diez M, Bertolotti A , et al. Orthotopic heart transplantation in elderly patients: a 10-year experience at a single center. Transplant Proc 2004; 36 (6) 1692-1694
- 9 Blanche C, Blanche DA, Kearney B , et al. Heart transplantation in patients seventy years of age and older: a comparative analysis of outcome. J Thorac Cardiovasc Surg 2001; 121 (3) 532-541
- 10 Kilic A, Weiss ES, Yuh DD, Shah AS, Conte JV. Factors associated with 5-year survival in older heart transplant recipients. J Thorac Cardiovasc Surg 2012; 143 (2) 468-474
- 11 Stevenson LW. The urgent priority for transplantation is to trim the waiting list. J Heart Lung Transplant 2013; 32 (9) 861-867
- 12 Bernhardt AM, Rahmel A, Reichenspurner H. The unsolved problem of organ allocation in times of organ shortage: the German solution?. J Heart Lung Transplant 2013; 32 (11) 1049-1051s
- 13 Smits JM, de Vries E, De Pauw M , et al. Is it time for a cardiac allocation score? First results from the Eurotransplant pilot study on a survival benefit-based heart allocation. J Heart Lung Transplant 2013; 32 (9) 873-880