Marelli Daniel, Kobashigawa Jon, Hamilton Michele A, Moriguchi Jaime D, Kermani Reza, Ardehali Abbas, Patel Jignesh, Noguchi Emily, Beygui Ramin, Laks Hillel, Plunkett Mark, Shemin Richard, Esmailian Fardad
David Geffen School of Medicine, Heart Transplant Program, University of California, Los Angeles, Los Angeles, California, USA.
J Heart Lung Transplant. 2008 Aug;27(8):830-4. doi: 10.1016/j.healun.2008.05.006. Epub 2008 Jun 25.
Heart transplantation 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.
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.
At 100 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 81% 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).
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 warrants 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.
心脏移植在老年人中越来越普遍。在20世纪90年代中期，我们项目中25%的受者年龄大于62岁。我们评估了一家机构的结果，假设老年受者可能面临与免疫抑制相关的主要并发症的更高风险。
我们分析了1995年1月至2001年7月在一家机构接受心脏移植的182例年龄在62至75岁（平均±标准差：66.3±11.4岁）患者的结果。将他们与同期348例年龄在18至62岁（平均±标准差：48.2±11.4岁）的成年受者对照组进行比较。该连续队列中的所有受者至少随访了5年。研究的终点是100个月时的Kaplan-Meier生存率、无透析生存率和无恶性肿瘤生存率。100个月时的随访率为100%。
100个月时，老年患者的生存率为55%（46例仍有风险），对照组为63%（102例仍有风险）（p = 0.051，对数秩检验）。通过回归分析，再次移植和透析可预测生存率，但受者年龄或恶性肿瘤则不能（p分别为0.003、<0.001、0.53和0.84）。100个月时老年患者的无恶性肿瘤生存率为68%，对照组为95%（p < 0.001）。通过回归分析，年龄可预测恶性肿瘤（p < 0.001）。100个月时，老年患者的无透析生存率为81%，对照组为87%（p = 0.005）。术前肌酐水平可预测透析需求，但年龄不能（p分别为0.003和0.47）。
尽管老年心脏移植受者的长期生存率是可以接受的，但明显低于年轻受者。老年患者肾衰竭和恶性肿瘤风险的增加可能影响两组观察到的生存率差异。术前肾功能值得仔细考虑。随着心室辅助装置技术的改进，它可用于补充心脏移植，以避免老年晚期心力衰竭患者的免疫抑制及其恶性肿瘤副作用。
