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Outcomes in patients older than 60 years of age undergoing orthotopic heart transplantation: an analysis of the UNOS database.

Abstract

BACKGROUND

Patients 60 years and older have traditionally not been considered candidates for orthotopic heart transplantation (OHT). Recent studies have shown equivalent survival between older and younger patients, leading many to question this traditional ethos. As these studies may lack significant power to draw meaningful conclusions, the United Network for Organ Sharing (UNOS) database provides a unique opportunity to examine the effects of age on OHT.

METHODS

We retrospectively reviewed the UNOS dataset to identify 14,401 first-time OHT recipients between the years 1999 and 2006. Stratification was by age into those >or=60 years and younger patients aged 18 to 59 years. Baseline demographic and clinical factors were recorded. The primary end-point was all-cause mortality during the study period. Secondary outcomes included length of hospital stay (LOS), post-operative stroke, post-operative infections, acute renal failure (ARF) and rejection within 1 year of transplant. Post-transplant survival was modeled using the Kaplan-Meier method and compared between groups using Cox proportional hazard regression.

RESULTS

Of the 14,401 patients who met the inclusion criteria, 30% (n = 4,273) were >or=60 years of age. The elderly group had higher serum creatinine levels (1.5 vs 1.3, p < 0.001), longer waitlist times (255 vs 212 days, p < 0.001), and were more likely to have hypertension (HTN; 46% vs 37%, p < 0.001) or diabetes mellitus (DM; 25% vs 20%, p < 0.001). Survival at 30 days, 1 year and 5 years was 94%, 87% and 75% for the young group, and 93%, 84% and 69% for the older group (p < 0.001). Multivariate analysis revealed age >or=60 years, donor age, ischemic time, creatinine, HTN and DM to be independent predictors of mortality. Older patients had more infections (26% vs 23%, p < 0.001), ARF (9% vs 7%, p < 0.001) and longer LOS (21 vs 19 days, p < 0.001), but had lower rates of rejection (34% vs 43%, p < 0.001) as compared with younger recipients.

CONCLUSIONS

The UNOS database has provided a large multi-institutional sample examining OHT in the elderly. Although our analysis shows lower survival in patients >or=60 years of age, the cumulative 5-year survival in these patients of close to 70% is acceptable. OHT should not be restricted based on age, as encouraging long-term results exist.

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  • Authors+Show Affiliations

    ,

    Division of Cardiac Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21231, USA. eweiss3@jhmi.edu

    , ,

    Source

    MeSH

    Age Factors
    Aged
    Cause of Death
    Female
    Follow-Up Studies
    Graft Rejection
    Graft Survival
    Heart Transplantation
    Hospital Mortality
    Humans
    Logistic Models
    Male
    Middle Aged
    Multivariate Analysis
    Postoperative Complications
    Probability
    Proportional Hazards Models
    Registries
    Retrospective Studies
    Risk Assessment
    Survival Analysis
    Transplantation, Homologous
    Treatment Outcome

    Pub Type(s)

    Comparative Study
    Journal Article
    Research Support, U.S. Gov't, P.H.S.

    Language

    eng

    PubMed ID

    18267225

    Citation

    Weiss, Eric S., et al. "Outcomes in Patients Older Than 60 Years of Age Undergoing Orthotopic Heart Transplantation: an Analysis of the UNOS Database." The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation, vol. 27, no. 2, 2008, pp. 184-91.
    Weiss ES, Nwakanma LU, Patel ND, et al. Outcomes in patients older than 60 years of age undergoing orthotopic heart transplantation: an analysis of the UNOS database. J Heart Lung Transplant. 2008;27(2):184-91.
    Weiss, E. S., Nwakanma, L. U., Patel, N. D., & Yuh, D. D. (2008). Outcomes in patients older than 60 years of age undergoing orthotopic heart transplantation: an analysis of the UNOS database. The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation, 27(2), pp. 184-91. doi:10.1016/j.healun.2007.11.566.
    Weiss ES, et al. Outcomes in Patients Older Than 60 Years of Age Undergoing Orthotopic Heart Transplantation: an Analysis of the UNOS Database. J Heart Lung Transplant. 2008;27(2):184-91. PubMed PMID: 18267225.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Outcomes in patients older than 60 years of age undergoing orthotopic heart transplantation: an analysis of the UNOS database. AU - Weiss,Eric S, AU - Nwakanma,Lois U, AU - Patel,Nishant D, AU - Yuh,David D, PY - 2007/07/24/received PY - 2007/11/12/revised PY - 2007/11/15/accepted PY - 2008/2/13/pubmed PY - 2008/3/28/medline PY - 2008/2/13/entrez SP - 184 EP - 91 JF - The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation JO - J. Heart Lung Transplant. VL - 27 IS - 2 N2 - BACKGROUND: Patients 60 years and older have traditionally not been considered candidates for orthotopic heart transplantation (OHT). Recent studies have shown equivalent survival between older and younger patients, leading many to question this traditional ethos. As these studies may lack significant power to draw meaningful conclusions, the United Network for Organ Sharing (UNOS) database provides a unique opportunity to examine the effects of age on OHT. METHODS: We retrospectively reviewed the UNOS dataset to identify 14,401 first-time OHT recipients between the years 1999 and 2006. Stratification was by age into those >or=60 years and younger patients aged 18 to 59 years. Baseline demographic and clinical factors were recorded. The primary end-point was all-cause mortality during the study period. Secondary outcomes included length of hospital stay (LOS), post-operative stroke, post-operative infections, acute renal failure (ARF) and rejection within 1 year of transplant. Post-transplant survival was modeled using the Kaplan-Meier method and compared between groups using Cox proportional hazard regression. RESULTS: Of the 14,401 patients who met the inclusion criteria, 30% (n = 4,273) were >or=60 years of age. The elderly group had higher serum creatinine levels (1.5 vs 1.3, p < 0.001), longer waitlist times (255 vs 212 days, p < 0.001), and were more likely to have hypertension (HTN; 46% vs 37%, p < 0.001) or diabetes mellitus (DM; 25% vs 20%, p < 0.001). Survival at 30 days, 1 year and 5 years was 94%, 87% and 75% for the young group, and 93%, 84% and 69% for the older group (p < 0.001). Multivariate analysis revealed age >or=60 years, donor age, ischemic time, creatinine, HTN and DM to be independent predictors of mortality. Older patients had more infections (26% vs 23%, p < 0.001), ARF (9% vs 7%, p < 0.001) and longer LOS (21 vs 19 days, p < 0.001), but had lower rates of rejection (34% vs 43%, p < 0.001) as compared with younger recipients. CONCLUSIONS: The UNOS database has provided a large multi-institutional sample examining OHT in the elderly. Although our analysis shows lower survival in patients >or=60 years of age, the cumulative 5-year survival in these patients of close to 70% is acceptable. OHT should not be restricted based on age, as encouraging long-term results exist. SN - 1557-3117 UR - https://www.unboundmedicine.com/medline/citation/18267225/Outcomes_in_patients_older_than_60_years_of_age_undergoing_orthotopic_heart_transplantation:_an_analysis_of_the_UNOS_database_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1053-2498(07)01405-2 DB - PRIME DP - Unbound Medicine ER -