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J Thorac Cardiovasc Surg 2004;127:1817-1819
© 2004 The American Association for Thoracic Surgery
Brief communication |
a Department of Surgery, Division of Cardiothoracic Surgery, College of Physicians and Surgeons, Columbia University, New York, NY, USA
Received for publication November 27, 2003; accepted for publication December 16, 2003.
* Address for reprints: Jeffrey A. Morgan, MD, Columbia University, College of Physicians and Surgeons, 177 Fort Washington Ave, Milstein Hospital 7GN-435, New York, NY 10032, USA
jm2240{at}columbia.edu
Several studies have demonstrated favorable results after orthotopic cardiac transplantation in recipients of advanced age.1-4 These studies have demonstrated similar survival in elderly patients as compared to that of younger patients undergoing heart transplantation. This has resulted in a relaxation of the upper age limit for cardiac transplantation in many centers. However, some transplant centers continue to view advanced recipient age as a contraindication to transplantation because of concerns regarding decreased survival in this cohort.5-7 This study was conducted to analyze and compare our experiences with older (70 years and older) versus younger (younger than 70 years) recipients with respect to perioperative and long-term survivals.
Patients and methods
Between January 1992 and February 2003, a total of 939 orthotopic cardiac transplants were performed at the New York Presbyterian Hospital–Columbia Medical Center, New York. Of these, 10 (1.1%) were performed in patients 70 years old or older (range 70.2-74.8 years). These patients were compared with patients younger than 70 years (range 18.3-69.8 years) at the time of transplantation. Pediatric patients (younger than 18 years; n = 115) were excluded. Outcome measures included perioperative and long-term posttransplantation survivals.
Statistical analysis
Data were represented as frequency distributions and percentages. Values of continuous variables were expressed as mean ± SD. Continuous variables were compared with paired t tests, whereas categorical variables were compared by means of 
2 tests. Kaplan-Meier analysis was used to calculate survival along with a log-rank P value when comparing groups. Actuarial survivals at 1, 3, 5, and 10 years after transplantation were calculated by constructing life tables. Significant predictors of mortality were identified with multivariate Cox proportional hazard models. All data were analyzed with the SPSS 11.5 software package (SPSS Inc, Chicago, Ill).
Results
Recipient data
Table 1 outlines the baseline clinical demographic data of patients in both groups. Mean ages were 72.2 ± 1.6 years (70.2-74.8 years) in the older group and 51.6 ± 12.6 years (18.3-69.8 years) in the younger group (P < .001). Sex and ethnicity distributions were similar in both groups (P = .339, P = .296, P = .229, P = .879). Left ventricular assist devices were present in a greater percentage of patients younger than 70 years (21.5% vs 0.0%), although the difference was not statistically significant (P = .099). There were no retransplantations in patients 70 years or older, versus 45 (5.5%) in patients younger than 70 years.
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Survival
Overall survivals are depicted in Figure 1. There was no statistically significant difference in long-term survival between the groups (P = .790). Actuarial survivals at 1, 3, 5, and 10 years were 89.5%, 89.5%, 89.5%, and 44.7%, respectively, for the older group, and 83.6%, 77.9%, 72.0%, and 51.8%, respectively, for the younger group.
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Discussion
With increases in life expectancy and thus in the elderly population, more elderly patients are being seen by cardiologists and cardiac surgeons for end-stage heart failure.8 There is an increased need for cardiac surgical procedures in the elderly population.8 Although transplantation is an effective treatment for end-stage heart failure, many transplant centers are reluctant to perform transplantation in elderly patients, even though there are data that indicate that this subgroup of patients can undergo transplantation with a survival similar to that of younger recipients.9-11
In our series of patients 70 years old or older at the time of transplantation, there was no significant difference in short or long-term survival with respect to patients younger than 70 years. Recipient age was not a risk factor for mortality and should not serve as a contraindication for transplantation. Limitations of this study include those related to a retrospectively performed analysis. Identification of clinical variables was obtained by chart review, which has inherent limitations, such as access and incompleteness of the data. Notwithstanding these limitations, our results argue that elderly patients should not be denied transplantation solely on the basis of advanced age. These patients deserve a careful medical evaluation to determine whether they are appropriate transplant candidates. When the procedure is performed in carefully selected elderly patients, it is associated with an outcome similar to that in younger patients.
References
This article has been cited by other articles:
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  Y. S. Tjang, G. J.M.G. van der Heijden, G. Tenderich, R. Korfer, and D. E. Grobbee Impact of Recipient's Age on Heart Transplantation Outcome Ann. Thorac. Surg., June 1, 2008; 85(6): 2051 - 2055. [Abstract] [Full Text] [PDF]
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