How old is too old for heart transplantation?

Heart transplantation is considered the treatment of choice for patients wi th advanced heart failure. Given the excellent results with transplantation , there has been growing pressure to liberalize eligibility criteria, espec ially with regard to age. Registry data and early reports have indicated th at there may be increased posttransplantation mortality in older patients. A number of single-center reports have shown that survival of older patient s may be similar to that of younger patients. The limited supply of donor h earts makes it imperative that careful consideration be given to transplant ation results in older recipients and to the overall impact that expanding eligibility criteria for transplantation will have. The limited supply of d onor hearts has also led to increased interest in the use of hearts from ol der donors. This review presents a current perspective on outcomes after he art transplantation in older recipients, use of older donor hearts, and the matching of donor and recipient risk. (C) 2000 Lippincott Williams & Wilki ns. Inc.