Abstract
Purpose: Heart transplantation in the elderly is increasingly common. Twenty five percent of recipients in our program are older than 62 years. Short-term results are well documented. Long-term (beyond 5 years) results are less well documented. We hypothesize that older transplant recipients would be at higher risk of major complications of immunosuppression. Methods and Materials: 182 patients aged 62-75 years (mean 66.3) underwent heart transplantation between January 1995 and July 2001. All recipients in this consecutive cohort had at least 5 years follow up. Endpoints studied were Kaplan-Meir survival and actuarial freedom from dialysis and malignancy. Follow up was 100%. The control group comprised 348 contemporaneous adult recipients aged 18-62 years (mean 48.2). Ischemic cardiomyopathy was the diagnosis for 60% of the recipients in the older age group, versus 41% for controls. Pre transplant serum creatinine level was 1.52 0.56 mg/dL for the older age group, versus 1.46 0.84 mg/dL for controls (p 0.34). Results: At 100 months, survival of the elderly was 55% (46 remaining at risk) vs. 63% (102 remaining at risk) for control (p 0.05). Retransplant and dialysis but not age or malignancy were predictive of survival by Cox regression analysis (p 0.003, p 0.001, p 0.53 and p 0.84 respectively). Freedom from malignancy for the elderly was 68% vs. 94.5% for controls (p 0.001). Age predicted malignancy by regression analysis (p 0.001). Freedom from dialysis for the elderly was 81% vs. 87% for controls. Preoperative serum creatinine level but not age was predictive of need for dialysis (p 0.003 and p 0.47). Conclusions: Although survival of elderly heart transplant recipients is comparable to that of younger recipients, poor renal function is a risk factor predicting long term survival. As improvements in VAD technology occur, such devices may complement heart transplant in order to avoid immunosuppression and its side effects of renal dysfunction and malignancy.
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