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

JOURNAL OF HEART AND LUNG TRANSPLANTATION

卷:35

Article

Cooper, Lauren B.^1,2  Lu, Di¹  Mentz, Robert J.^1,2  Rogers, Joseph G.^1,2  Milano, Carmelo A.^1,3  Felker, G. Michael^1,2  Hernandez, Adrian F.^1,2  Patel, Chetan B.^1,2 

[1] Duke Univ, Med Ctr, Duke Clin Res Inst, Durham, NC USA

[2] Duke Univ, Med Ctr, Dept Med, Div Cardiol, Durham, NC 27710 USA

[3] Duke Univ, Med Ctr, Dept Surg, Div Cardiovasc & Thorac Surg, Durham, NC 27710 USA

关键词: heart transplantation;    organ donor;    organ recipient;    septuagenarian;    aging;   

DOI  :  10.1016/j.healun.2015.10.028

来源: Elsevier

【 摘 要 】

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. (C) 2016 International Society for Heart and Lung Transplantation. All rights reserved.

【 授权许可】

Free