HEART TRANSPLANTATION IN THE OLDER RECIPIENT: INITIAL RESULTS OF A SINGLE CENTER EXPERIENCE

Abstract

405 Purpose: Advanced recipient age remains a contraindication for cardiac transplant (Tx) at many institutions and some multi-center registries have suggested there is a significant decrease in survival in older recipients. A liberalization of acceptance criteria at our institution has excluded age alone as a barrier to Tx. The purpose of this study was to determine if advanced age was an independent risk factor for morbidity and mortality post-Tx at our center. Methods: 356 patients (pts) underwent primary cardiac transplantation at our institution between 1992-1996. 26 pts (7%) in this population were age 64 or greater (64-69; mean=67). The younger group consisted of 330 pts (93%) who were age 63 or younger (18-63; mean=50). 9 pts in the older group and 73 pts in the younger group were on LVAD support at the time of Tx. Mean donor age was similar for each group (37 vs 32 yrs). Morbidity (development of allograft disease) and mortality post-tx were compared between the two groups of pts. Mean follow-up was 32 months. Results: There seemed to be little difference in outcomes for the two groups overall with the exception of post-op length of stay (13 vs 17days p=.04). Actuarial survival calculated by Kaplan-Meier did not indicate any significant difference between the two pt groups at 12 months(96% vs 89%), 24 months (96% vs 87%), or at 36 months (76% vs 84%). Freedom from allograft disease was not significantly different between the two groups(75% vs 88%) at 24 months of follow-up. Hospital charges from Tx to discharge among the two groups ($85,302 vs $108,153) were not significantly different. Additionally, LVAD survival by recipient age group did not show any significant difference at 24 months of follow-up (88%vs 86% p=ns).Conclusion: Our initial experience with cardiac transplantation in older recipients has not demonstrated an adverse effect on morbidity or mortality when compared to the younger recipient group. Additionally, the cost of Tx in this population is comparable to that of the younger cohort. These results would seem to indicate that cardiac transplantation appears to be a safe and effective option for older pts with end stage heart disease. This practice, however, is most likely to widen the gap between the number of potential heart donors and the growing number of pts awaiting transplant.