An analysis of the effect of age on survival after heart transplant

Background: Advances in immunosuppression and reports of improved survival after cardiac transplantation have led to a liberalization of traditional recipient eligibility criteria, especially age. While age alone is not a contraindication to transplantation, conflicting data exists regarding long-term survival of the older transplant recipient. Methods: One hundred-fifty three patients undergoing consecutive first time cardiac transplantation from June 7, 1985 through February 1, 1997 were studied. For purposes of analysis, patients were stratified according to age (less than or equal to 55 years vs >55 years) and hospital and late outcomes determined. Results: The incidence of early and late acute cellular rejection was not different based up on age. The freedom from infection at 12 months was 54 +/- 5% for patients less than or equal to 55 compared to 32 +/- 8% for patients >55 years old (p =.04). Five year estimated survival for patients >55 years old was only 56 +/- 9% compared to 78 +/- 5% for patients less than or equal to 55 years old (p =.005). The hazard for death was highest within the first post-transplant year for older patients and was most commonly due to infection. Both advanced age and pre-transplant diagnosis of ischemic cardiomyopathy were found to be independently and additively predictive of reduced late survival. Conclusions: In the present study, late survival was: adversely influenced by advanced age. Older patients (>55 years) with pre-transplant diagnosis of ischemic cardiomyopathy were particularly at high risk (risk ratio 4.6:1) for death. Given little prospect of expanding the number of donor hearts, careful selection of patients over the age of 55 with pre-transplant ischemic cardiomyopathy is warranted.