Heart Transplantation in Patients Older than 65 Years: Worthwhile or Wastage of Organs?

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 AE 2.2 vs. 51.5 AE 9.7 years), but gender (male 77.8 vs. 77.3%; p ¼ 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 AE 11.3 vs. 34.0 AE 11.0 years; p ¼ 0.014). Hospital mortality was 0 vs. 5.9% (p ¼ 0.095) and 1-and 5-year survival were 88.8 AE 4.7 versus 86.8 AE 2.4% and 81.5 AE 5.9 versus 77.2 AE 3.2%, respectively. Mean follow-up was 3.8 AE 2.7 versus 4.5 AE 3.1 years. Incidence of cellular/humoral rejection was similar, but incidence of cardiac allograft vasculopathy was higher (15.6 vs. 7.4%; p ¼ 0.081). Incidence of diabetes de novo was similar (p ¼ 0.632), but older patients had more serious infections in the 1st year (p ¼ 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.

Unplanned readmission of patients with heart transplantation in 1 year: A retrospective study

“…In this study, the most crucial factor affecting readmission was infection, which is similar to the result of a previous study that revealed that the main cause of death in 1 year after heart transplantation was infection (Prieto, Correia, Batista, & Jesus Antunes, ). Concerning rejection, far more individuals (58%) were readmitted in that study and specifically, those with slight rejection that did not require treatment.…”

“…In a previous study, 22 patients (8.8%) developed cardiac CAV (Prieto et al, 2015), compared with three patients (1.2%) in this study. These differences are thought to be related to the patients' age (65 years or older in Prieto et al, 2015) and to the preventative effects of CAV through appropriate early interventions such as the broad use of statins and new immunosuppressants among the participants of this study.…”

Coronary artery disease in heart transplantation: new concepts for an old disease

“…Altogether, these data can be interpreted by the concept that although recipient age may not be directly involved in the process of coronary lesions progression, older recipients bear more often multiple comorbidities and metabolic abnormalities that are related to increased risk of “standard” cardiovascular disease, and thus poor outcome. In support of this concept, older recipients with a low comorbidity profile show good outcomes after transplantation .…”

“…Of the 48 articles investigating risk factors for CAV, six had a prospective design , seven were subanalysis of multicenter registries , and 36 were retrospective mostly single‐center cohort studies (Table ). In most of the studies, several factors emerged from the analysis as associated with CAV, but it has to be noted that only few were consistently reported in all studies, which analyzed widely variable sets of risk factors.…”

“…Donor age, when analyzed, is consistently reported to be associated with CAV detection []. This concept is not novel and is mainly related to the risk of transmission of donor coronary lesions to the recipient, as also suggested by studies finding that male donors – more likely to bear subclinical coronary lesions – may be associated with CAV development .…”