Long-term results of heart transplantation deteriorate more rapidly in patients over 60 years of age.

It is generally agreed that the upper age limit for heart transplantation is 60 years. However, an increasing number of elderly candidates are accepted for heart transplantation. We retrospectively analyzed our experience with a total of 204 consecutive transplantations, performed in 195 adult patients (9 retransplantations) between March 1987 and September 1993. There were 48 patients older than 60 years (mean 62.9 +/- 3), group I (gr I) and 156 patients between 20 and 59 years old (mean 47.5 +/- 8), group II (gr II). The two groups were matched for sex-ratio (female 10.4 vs 14.2%), indications (cardiomyopathy, ischemic, others), and hemodynamic parameters (pulmonary artery pressure, capillary wedge pressure, cardiac index). A ventricular assist device was used in 14 patients as bridge to transplantation in gr II vs 0 to gr I. There were seven early deaths in gr I (14.6%) vs 14 in gr II (8.97%, NS). A total of 183 survivors (41 vs 142) have been followed up for 1 month-6.3 years (mean follow-up 20.4 +/- 19.3 months in gr I, 35.4 +/- 23 in gr II). No patient was lost to follow-up. There were 11 late deaths in gr I vs 16 in gr II. The most common cause was malignancy (n = 4) in gr I and sudden death (n = 9) in gr II, with a significant difference. The actuarial survival was 68.8% in gr I vs 88.5% in gr II at 1 year 43.5% in gr I vs 76.4% in gr II at 5 years. In conclusion, transplanted patients over 60 years of age have a significantly poorer late survival than younger patients, despite similar good early results. Moreover, the causes of late deaths were different in the two groups. So, heart transplantation in patients over 60 years of age should be carefully considered.