HEART-TRANSPLANTATION AS A TREATMENT OPTION FOR END-STAGE HEART-DISEASE IN PATIENTS OLDER THAN 65 YEARS OF AGE

Because of the critical donor organ shortage for heart transplantation , selection of recipients should be based on the potential for maximum benefit. To evaluate the effects of advancing age on outcome after he art transplantation, we compared the clinical variables of 12 recipien ts aged 65 years or older (66.1 +/- 0.9 years x +/- standard deviatio n!; range, 65 to 67 years) with those of 57 patients aged 55 to 64 yea rs (59.3 +/- 2.7 years) at the time of the procedure. The two study gr oups were similar in sex, race, pretransplantation heart disease, immu nocompatibility, maintenance immunosuppression, and length of first ho spitalization at the time of the procedure. Groups were also similar r egarding the incidence of malignancies, fractures, diabetes, neurologi c complications, and renal dysfunction occurring over the follow-up pe riod. Patients 65 years of age or older had a significantly higher num ber of hospital days (36 +/- 29 versus 15 +/- 18 days; p < 0.02) and i ncreased frequency of infections/month (0.7 +/- 0.3 versus 0.3 +/- 0.4 infections/month; p < 0.03) during the first postoperative year. Olde r patients had a higher incidence of cytomegalovirus infections (50% v ersus 19%; p < 0.06), lower rates of rejection at 1 and 6 months after operation (p < 0.03), and more severe functional limitation (p < 0.00 2) than patients aged 55 to 64 years. One-year actuarial survival was not significantly different in the two groups. The results of our stud y suggest that, because of lower rejection and higher infection rates, heart transplantation recipients older than 65 years of age should re ceive less intense immunosuppression. Because after heart transplantat ion patients 65 years of age and older do not improve functionally as dramatically as younger patients, age-related comorbidities that may a dversely affect outcome. should be carefully evaluated when considerin g older patients for heart transplantation.