Long-term outcomes of heart transplantation in older recipients

被引：20

作者：

Marelli, Daniel ^{[1
]}

Kobashigawa, Jon ^{[1
]}

Hamilton, Michele A. ^{[1
]}

Moriguchi, Jaime D. ^{[1
]}

Kermani, Reza ^{[1
]}

Ardehali, Abbas ^{[1
]}

Patel, Jignesh ^{[1
]}

Noguchi, Emily ^{[1
]}

Beygui, Ramin ^{[1
]}

Laks, Hillel ^{[1
]}

Plunkett, Mark ^{[1
]}

Shemin, Richard ^{[1
]}

Esmailian, Fardad ^{[1
]}

机构：

[1] Univ Calif Los Angeles, David Geffen Sch Med, Heart Transplant Program, Los Angeles, CA 90095 USA

来源：

JOURNAL OF HEART AND LUNG TRANSPLANTATION | 2008年 / 27卷 / 08期

关键词：

D O I：

10.1016/j.healun.2008.05.006

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background: Heart trans. plantation in the elderly is increasingly common. in the mid-1990s, 25% of recipients in our program were >62 years of age. We evaluated outcomes from one institution with the hypothesis that older recipients may be at higher risk of major complications associated with immunosuppression. Methods: We analyzed results for 182 patients aged 62 to 75 years (mean +/- SD: 66.3 +/- 11.4 years) who underwent heart transplantation between January 1995 and July 2001 at a single institution. They were compared with a control group of 348 contemporaneous adult recipients aged 18 to 62 years (mean +/- SD: 48.2 +/- 11.4 years). All recipients in this consecutive cohort had a follow-up of at least at least 5 years. End-points studied were Kaplan-Meier survival, freedom from dialysis and freedom from malignancy at 100 months. Follow-up was 100% at 100 months. Results: At 106 months, survival for the elderly was 55% (46 remaining at risk) and 63% (102 remaining at risk) for controls (p = 0.051, log-rank test). Re-transplant and dialysis, but not recipient age or malignancy, were predictive of survival by regression analysis (P = 0.003, P < 0.001, P = 0.53 and p = 0.84, respectively). Freedom from malignancy at 100 months was 68% for the elderly and 95% for controls (p <,0.001). Age predicted malignancy by regression analysis (p < 0.001). At 100 months, freedom from dialysis was 81516 for the elderly and 87% for controls (P = 0.005). Pre-operative creatinine, but not age, was predictive of need for dialysis (p 0.003 and p = 0.47, respectively). Conclusions: Although long-term survival of older heart transplant recipients is acceptable, it is significantly lower than in young recipients. The increased risk of renal failure and malignancy among elderly patients likely influences the difference in survival observed between, the two groups. Pre-operative renal function wan-ants careful consideration. As ventricular assist device technology improves, it may be used to complement heart transplantation to avoid immunosuppression and its side effect of malignancy in older patients with advanced heart failure.

引用

页码：830 / 834

页数：5

共 14 条

[1] Renal function and safety of heart transplant recipients switched to mycophenolate mofetil and low-dose cyclosporine [J].