Heart transplantation in elderly patients

During 1985 to 1986, 57 orthotopic heart transplantations have been performed at the University of Minnesota, Minneapolis. All patients received triple-drug immunosuppressive therapy of cyclosporine, azathioprine, and prednisone. Twenty-three patients were aged 55 years or older (mean age 58.0 ± 2.6 years); 34 patients were under the age of 55 years (mean age 39.1 ± 13.2 years). The initial in-hospital stay average 13 ± 4 days in the older group and 16 ± 13 days in the younger group. Perioperative mortality was similar in the two groups. The incidence of cerebrovascular accident was similarly low in the two groups, whereas incidence of steroid-induced diabetes (17% versus 9%) and significant osteoporosis (13% versus 3%) was significantly higher in older patients. The probability of survival and the actuarial freedom from rejection were identical in the two groups with 1-year survival of 96% and 94% of patients free of rejection at 12 months. Although the incidence of infection was not significantly higher in older patients (0.82 episode per patient) than in younger patients (0.78 episode per patient), life-threatening infections (Cryptococcus meningitidis, disseminated herpes simplex) were observed only in older patients. These data suggest that (1) heart transplantation is a valid therapeutic option even in elderly patients with end-stage heart failure, (2) it can be performed in selected patients at no increased operative risk with excellent long-term survival, (3) however, older patients are at higher risk for serious infections and for developing steroid-related complications.