HEART-TRANSPLANTATION IN PATIENTS OVER 54 YEARS OF AGE - MORTALITY, MORBIDITY AND QUALITY-OF-LIFE

Aims As a consequence of recent advances in heart transplantation, upp er age limits for the procedure have been liberalized in many centres. It was the purpose of this study to compare post-transplant mortality , morbidity and quality of life in a consecutive series of 72 patients >54 years (mean age, 57.6 +/- 2.7 years) with a control group of 72 a dult patients less than or equal to 54 years (mean age, 42.4 +/- 9.5 y ears) transplanted at one centre between 1985 and 1991. Methods and re sults Patients were followed for 41 +/- 27 months post-transplant. Act uarial 1-, 5- and 7-year survival rates were 78 +/- 5%, vs 81 +/- 5%, 52 +/- 7% vs 66 +/- 6% and 46 +/- 8% vs 63 +/- 6% in patients >54 year s and less than or equal to 54 years, respectively (P=ns). Causes of d eath were not significantly different between the groups. Patients >54 years experienced significantly fewer rejection episodes after the 6t h month post-transplant (0.5 +/- 0.9 vs 0.9 +/- 1.0, P<0.04), and inci dence and treatment of rejection episodes as well as incidence of infe ction was comparable between the groups. Non-lymphoid malignancies, ma inly skin cancer, occurred more often in the older age group (27% vs 1 3%, P<0.05). Quality of life, as assessed by the Nottingham Health Pro file, was better in 5/6 dimensions of social functioning in older pati ents and the diffennce reached statistical significance for the dimens ions of emotional reactions (P=0.005) and sleep (P=0.000). Conclusion In conclusion, carefully selected patients >54 years can undergo heart transplantation with mortality and morbidity comparable to younger pa tients. Quality of life post-transplant seems even to be slightly bett er in the older age group.