Heart Transplantation in an Aging Society: An Analysis of 25 Years of the OPTN/UNOS Registry.
Hörmann M, Everly MJ.
Clinical Transplants 2013, Chapter 4
The annual number of adult heart transplantations in the United States is still low due to a lack of donor organs. Median long-term survival has been improved by about 1.7 years over the last 12 years. The aging of society is reflected in the United Network for Organ Sharing data, with more patients older than 70 years old receiving cardiac transplantation. The rate of acute rejection is higher in the group of younger patients, whereas older patients suffer from renal failure. They die more often from infection and malignancies, most likely due to immunosuppression. In the multivariate analysis, fewer factors are influencing their 5-year graft survival compared to that of younger patients. Increasing donor age raises their risk of death and graft failure by 1.8% per year of age. The long-term survival is significantly worse for the elderly, but the 1- and 5-year survival is acceptable. Therefore, heart transplantation in the elderly is still justified. Older patients need to be carefully selected, their immunosuppressive therapy needs to be adjusted, and they have to be monitored more closely concerning renal function, blood-levels of immunosuppressive drugs, infections, and malignancies to improve their survival.