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Cardiac transplantation for older patients: Characteristics and outcomes in the septuagenarian population.

Publication ,  Journal Article
Cooper, LB; Lu, D; Mentz, RJ; Rogers, JG; Milano, CA; Felker, GM; Hernandez, AF; Patel, CB
Published in: J Heart Lung Transplant
March 2016

BACKGROUND: With increasing age of patients with heart failure, it is important to understand the potential role for orthotopic heart transplant (OHT) in elderly patients. We examined recipient and donor characteristics and long-term outcomes of older recipients of OHT in the United States. METHODS: Using the United Network for Organ Sharing database, we identified OHT recipients from the years 1987-2014 and stratified them by age 18-59 years old, 60-69 years old, and ≥70 years old. We compared baseline characteristics of recipients and donors and assessed outcomes across groups. RESULTS: During this period, 50,432 patients underwent OHT; 71.8% (n = 36,190) were 18-59 years old, 26.8% (n = 13,527) were 60-69 years old, and 1.4% (n = 715) were ≥70 years old. Comparing the ≥70 years old group and 60-69 years old group, older patients had higher rates of ischemic etiology (53.6% vs 44.9%) and baseline renal dysfunction (61.4% vs 56.4%) and at the time of OHT were less likely to be currently hospitalized (45.0% vs 50.9%) or supported with left ventricular assist device therapy (21.0% vs 28.3%). Older recipients received organs from older donors (median age 36 years old vs 30 years old) who were more likely to have diabetes and substance use. After OHT, the median length of stay was similar between groups. At 1 year, of patients alive, patients ≥70 years old had fewer rejection episodes (17.8%) compared with patients 60-69 years old (29.5%). The 5-year mortality was 26.9% for recipients 18-59 years old, 29.3% for recipients 60-69 years old, and 30.8% for recipients ≥70 years old. CONCLUSIONS: Despite advanced age and less ideal donors, OHT recipients in their 70s had similar outcomes to recipients in their 60s. Selected older patients should not routinely be excluded from consideration for OHT.

Duke Scholars

Published In

J Heart Lung Transplant

DOI

EISSN

1557-3117

Publication Date

March 2016

Volume

35

Issue

3

Start / End Page

362 / 369

Location

United States

Related Subject Headings

  • Young Adult
  • Treatment Outcome
  • Surgery
  • Retrospective Studies
  • Middle Aged
  • Male
  • Humans
  • Heart Transplantation
  • Female
  • Cohort Studies
 

Citation

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Cooper, L. B., Lu, D., Mentz, R. J., Rogers, J. G., Milano, C. A., Felker, G. M., … Patel, C. B. (2016). Cardiac transplantation for older patients: Characteristics and outcomes in the septuagenarian population. J Heart Lung Transplant, 35(3), 362–369. https://doi.org/10.1016/j.healun.2015.10.028
Journal cover image

Published In

J Heart Lung Transplant

DOI

EISSN

1557-3117

Publication Date

March 2016

Volume

35

Issue

3

Start / End Page

362 / 369

Location

United States

Related Subject Headings

  • Young Adult
  • Treatment Outcome
  • Surgery
  • Retrospective Studies
  • Middle Aged
  • Male
  • Humans
  • Heart Transplantation
  • Female
  • Cohort Studies