Septuagenarians should not be routinely excluded from heart transplantation

NATIONAL HARBOR, Md. — A review of donor and recipient characteristics of orthotopic heart transplantations suggests that select patients aged 70 years and older should not be omitted as candidates for transplant due to advanced age alone.

“With the increasing age of the HF population, it is important to understand the potential role for orthotopic heart [transplantation] in older patients,” the researchers wrote. “We examined recipient and donor characteristics and long-term outcomes of older [orthotopic heart transplantation] recipients in the [United States].”

Lauren B. Cooper, MD, from Duke University School of Medicine, and colleagues evaluated 50,432 heart transplantation recipients in the United Network for Organ Sharing (UNOS) database. All recipients were aged 18 years and older. The researchers performed a retrospective analysis of transplants from January 1987 to March 2014. Recipients were grouped by age: 18 to 59 years (71.8%); 60 to 69 years (26.8%); and septuagenarians older than 70 years (maximum age, 79 years; 1.4%).

Compared with age 60 to 69 years, recipients aged 70 years and older had increased ischemic etiology (53.6% vs. 44.9%) and baseline renal dysfunction (61.4% vs. 56.4%; P < .01 for both). At the time of transplantation, older patients were less likely to be hospitalized (45% vs. 50.9%) and supported with left ventricular assist device therapy (21% vs. 28.3%; P < .01 for both) than younger patients. The median length of stay following heart transplantation was 14 days for recipients aged younger than 60 years and 15 days for recipients aged 60 years and older.

When the researchers analyzed data on recipients alive at 1 year after transplantation, those aged 70 years and older had lower rates of rejection in the first year (17.8%) compared with those aged 60 to 69 years (29.5%). Five-year mortality was highest among patients aged 70 years and older (30.8%), followed by those aged 60 to 69 years (29.3%) and 18 to 59 years (26.9%).

Septuagenarians generally received organs from older donors (median age of donor, 36 years). The median donor age for recipients in the 60- to 69-year age range was 30 years and the median donor age in the 18- to 59-year age range was 28 years. Donors for the oldest age group were most likely to have diabetes and use tobacco, alcohol and cocaine.

“In the United States, the rate of transplantation for older adults is increasing,” Cooper said. “Septuagenarians selected for heart transplant were less acutely ill at the time of transplant and tended to receive organs from older donors with high-risk behaviors. Despite advanced age, these patients had similar outcomes to younger age groups. Thus, select septuagenarians should not routinely be excluded from consideration for heart transplant, but we want to highlight that appropriate patient selection is paramount when considering these patients for cardiac transplant.” – by Julia Ernst, MS

References:

Cooper LB, et al. Rapid Fire Abstracts 1. Presented at: Heart Failure Society of America Annual Scientific Meeting; Sept. 26-29, 2015; National Harbor, Md.

Cooper LB, et al. J Card Fail. 2015;doi:10.1016/j.cardfail.2015.06.065.

Disclosure: Cooper reports no relevant financial disclosures.