4 years ago

Comparison of Clinical Characteristics, Complications, and Outcomes in Recipients Having Heart Transplants <65 Years of Age Versus ≥65 Years of Age

Advanced recipient age remains a limiting factor for heart transplant candidacy, with many centers reluctant to transplant older patients. Here we report our experience with recipients aged ≥65 years compared with younger recipients in terms of baseline characteristics, intra-operative and immediate postoperative experiences, and post-transplant morbidity and survival. The main study outcome was primary graft dysfunction (PGD), which has not be widely studied in this population. Donor and recipient data from 255 heart transplantations performed between 2012 and 2016 were reviewed. Seventy (27%) recipients were ≥65 years and 185 were younger. The older group had a higher frequency of ischemic cardiomyopathy and more frequently had a previous sternotomy than the younger recipients (all P<0.007). We found no significant differences in post-transplant morbidity (intensive care unit and hospital stay, pneumonia, infections, re-operation for bleeding, stroke, renal failure or in-hospital mortality; all P>0.12). One-year survival was also similar in the 2 groups (P= 0.88). The incidence of moderate or severe PGD was lower in the older group (6%) than in the younger group (16%; P=0.037). Multivariate logistic regression found pre-transplant creatinine and donor undersizing by predicted heart mass to be predictors of moderate to severe PGD, while recipient age ≥65 years was identified as protective against PGD in this cohort. In conclusion, our study showed comparable survival and outcomes in recipients ≥65 years of age with otherwise similar nutritional status and body mass composition.

Publisher URL: www.sciencedirect.com/science

DOI: S0002914917314649

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