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Eur J Cardiothorac Surg 2003;24:283-291
© 2003 Elsevier Science NL

Long-term survival (>10 years) of patients >60 years with induction therapy after cardiac transplantation

Department of Cardiothoracic Surgery, University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria

Received 26 September 2002; received in revised form 13 March 2003; accepted 17 March 2003.

^* Corresponding author. Tel.: +43-1-40400-5643; fax: +43-1-40400-5642
e-mail: 101634.174{at}compuserve.com

Objective: Cardiac transplantation has become an established method for end-stage heart disease. Short- and mid-term outcome has been known to be similar between younger and older (>60 years) recipients. So far, nothing is known about long-term outcome of old patients and the potential long-term effects of antibody induction therapy in these patients. The purpose of this study was to analyse long-term outcome of old cardiac transplant recipients who underwent antibody induction therapy. Methods: Since 1989, 203 patients (total n=882) above 60 years have been transplanted at our center. On these patients n=66 were above 65 years. Survival, incidences of rejection, infection, cancer, graft arteriosclerosis and the amount of renal insufficiency were compared with patients <60 years (n=679), transplanted during the same period of time. Freedom from specific event was computed by Kaplan–Meier analysis and compared by log–rank test. Results: Ten year survival was similar in all groups (<60 years: 53.7%; 60–64 years: 53.1% and >65 years: 60.2%; P=NS). Causes of death were similar in all patient groups. There were significant fewer rejection episodes in the older patient group (freedom from rejection: 74.9 vs. 83.5 vs. 90.6; P=0.03). Yet significantly more number of patients >65 years were without steroid maintenance therapy (43.1%) compared to other patient groups (8.2 vs. 9.3%; P<0.05). There was no difference in overall freedom from severe infection (74.1 vs. 67.7 vs. 85.3%; P=NS), whereas there was a trend towards more CMV disease in the oldest patient group (82.7 vs. 88.6 vs. 70.8%; P=0.06). The incidence of cancer was similar in all groups (freedom from cancer: 82.2 vs. 84.7 vs. 79.1%; P=NS), as well as there was no difference in severe graftsclerosis between all patients (79.2 vs. 93.7 vs. 93.3%; P=NS). There was no difference in development of chronic renal dysfunction (creatinine >2.0 mg/dl) between the three groups (10 vs. 14 vs. 16%; P=NS). Conclusions: Old recipients of cardiac transplants have a similar long-term outcome than younger recipients. They were less prone to rejections, had a similar incidence of severe infections and showed a trend towards more CMV disease. All patients had a very low rate of graft arteriosclerosis that was similar amongst the groups. Age-related decline of the immune system further enhanced by immunomodulation of antibody induction therapy might be accounted for the results as well as steroid-free immunosuppression.

Key Words: Cardiac transplantation • Age • Risk factors • Survival • Antibody induction therapy

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