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J Thorac Cardiovasc Surg 2003;126:224-231
© 2003 The American Association for Thoracic Surgery

Cardiothoracic transplantation

Long-term results of heart transplantation in patients older than 60 years

^a Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif.USA

Received for publication September 14, 2002; accepted for publication November 1, 2002.

^* Address for reprints: Robert C. Robbins, MD, Department of Cardiothoracic Surgery, Falk Cardiovascular Research Center, Stanford University School of Medicine, 300 Pasteur Dr, Stanford, CA 94305-5247, USA
robbins{at}stanford.edu

BACKGROUND: Advanced age has been traditionally considered a relative contraindication for heart transplantation. Older patients are now considered as potential candidates for heart transplantation. The objective of this study was to evaluate the long-term results of heart transplantation in patients older than 60 years.

METHODS: Between 1986 and 2001, 81 patients aged between 60 and 70 years (mean, 63 ± 2 years) underwent heart transplantation. These patients were compared with 403 adult recipients younger than 60 years (mean, 47 ± 11 years) who underwent transplantation during the same period.

RESULTS: Thirty-day mortality was 6% (5/81) and 6% (25/403) in the older and younger patients, respectively (P = NS). Actuarial survival at 1, 5, and 10 years was 88% ± 4% versus 83% ± 2%, 75% ± 5% versus 69% ± 2%, and 50% ± 9% versus 51% ± 3% in the older and younger patients, respectively (P = NS). Older patients had significantly fewer rejection episodes (P = .003). Freedom from allograft coronary artery disease at 1, 5, and 10 years was 98% ± 2% versus 92% ± 2%, 85% ± 6% versus 76% ± 3%, and 81% ± 7% versus 68% ± 3% (P = .1). The incidences of infectious complication, cytomegalovirus infection, and posttransplant lymphoproliferative disorder were similar between the 2 groups, but older recipients were more likely to have a nonposttransplant lymphoproliferative disorder cancer (P = .002). Age at transplantation was not identified as an independent risk factor for early and late death.

CONCLUSION: Heart transplantation in selected patients aged 60 years and older results in survival comparable with that of younger patients. Older patients have a lower risk of rejection but an increased risk of development of a nonposttransplant lymphoproliferative disorder cancer. Advanced age per se should not be considered as an exclusion criterion for transplantation.

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