Reduced Long-term Outcomes after Orthotopic Heart Transplantation in Septuagenarians

Advanced age has been viewed as a contraindication to orthotopic heart transplantation (HTx). We sought to evaluate the clinical outcomes after HTx in patients 70 years and older compared with younger patients. We retrospectively reviewed 948 consecutive patients who underwent HTx between 2000-2012. Patients were divided into three age groups: ≥ 70-years (group 1, n = 34), 60 to 69 years (group 2, n = 306), and < 60 years (group 3, n = 608). Primary endpoints were in-hospital mortality, and long-term survival at 10-year follow-up. Secondary outcomes included post-HTx complications including extended intubation, need for dialysis, and re-operation for bleeding. Compared to other groups, recipients in group 1 were predominantly male, had primarily ischemic etiology, higher rates of hypertension and smoking, were less likely to be diabetic, and had lower baseline estimated glomerular filtration (p<0.01, each variable). No difference in donor characteristics was noted between groups other than donor age (42.2±14.1 vs. 35.8±13.2 vs. 32.3±13.1, respectively, p<0.001). Gender mismatch rate, donor/recipient weight disparity, and mean ischemic time was equivalent among groups. In-hospital mortality rate was 11.8 % in Group 1, 8.5% in Group 2, and 5.1% in Group 3 (p=0.062). Mean follow-up duration was 5.95±4.02 years. Survival in group 1 was significantly reduced compared to group 3 (log-rank p = 0.013), for the first 10 years after OHT. Older patients (Group 1) were at risk for prolonged intubation (p=0.04), and a trend for re-operation for bleeding and dialysis (both p=0.09), which directly correlated with increasing age. Patients who age 70 years and older may undergo HTx albeit with slightly higher morbidity and mortality in the long-term when compared with younger recipients. Careful evaluation of comorbidities should be conducted prior to transplantation in this group.