RARE INDICATION - HEART-TRANSPLANTATION IN RECIPIENTS AGED 70 YEARS AND OLDER

Background The upper age limit for heart transplantation has gradually been raised. Medical opinion still considers this otherwise routine p rocedure to be an exception for elderly recipients. The main arguments against transplantation in elderly patients are shortage of donors an d expected poor results due to organ dysfunction or de novo neoplasms. We retrospectively evaluated the early and late post-operative course s, the effect of heart recipients aged 70 years or older on survival r ates, and quality of life. Methods The early and long-term outcomes of nine patients aged 70-77 years (mean 72 years) who had undergone orth otopic heart transplantation at our centre were analysed retrospective ly. Their donors were aged between 31 and 64 years (mean 52 years). Im munosuppression was carried out routinely without mono- or polyclonal antibody induction therapy, and consisted of cyclosporine A, azathiopr ine and methylprednisolone during the early pre- and post-operative co urse; subsequent maintenance therapy was based solely on cyclosporine A wherever possible. Endomyocardial right Ventricular biopsies were ca rried out only during the first 12 months after heart transplantation. Results Two of the nine patients died; the other seven are all long-t erm survivors. Coronary angiography has shown no evidence of relevant graft sclerosis. In five recipients, long-term immunosuppression maint enance consists solely of cyclosporine A as basic monotherapy, Two rec ipients require a triple drug therapy comprising cyclosporine A, azath ioprine and prednisone. Conclusions in individual cases, heart transpl antation is indicated in recipients aged greater than or equal to 70 y ears. The operative risk is low, the survival time and quality of life high. The inclusion of older recipients within our heart transplantat ion programme seems to have had no influence on the mortality of young er recipients because hearts from older donors and hearts from donors with extended donor criteria for transplantation were used. There is n o justification for excluding recipients aged greater than or equal to 70 years from heart transplantation.