Heart transplantation in selected patients aged 60 years and older: a two-decade retrospective and multicentre analysis.
OBJECTIVES
This study analysed survival and long-term outcomes of heart transplantation in patients aged 60 years and older. We also analysed the impact of a national graft allocation priority [Super Emergency (SE)] and compared survival with younger patients in our centres and in France.


METHODS
We performed a multicentre (University Hospitals in Nantes, Rennes and Tours), 2-decade retrospective study between 1 January 1994 and 31 December 2013. Elderly recipients were placed on the same list as younger patients; the use of marginal donors remained occasional.


RESULTS
A total of 212 patients aged between 60 and 68 years were included. The 1-, 5-, and 10-year survival rates were 83.2%, 77.4% and 63.8%, respectively, which were significantly worse than those of recipients aged <60 years (1-, 5-, and 10-year survival rates of 87.3%, 80.4% and 68.0%, respectively). The postoperative course was acceptable. The main cause of death was malignancy (29.8% in our cohort). Survival was similar between the first and second decades and among the SE group. Our population exhibited better survival than patients <60 years transplanted in France during the same period with 1-, 5-, and 10-year survival rates of 76.8%, 68.0% and 56.3%, respectively. Predictors of survival in the multivariate analysis included ischaemic cardiomyopathy [hazard ratio (HR) 4.1] and postoperative complications, such as dialysis (HR 9.5) and mechanical circulatory support (HR 4.2).


CONCLUSIONS
We report positive postoperative course and long-term outcomes after heart transplantation in older recipients using conventional donors. Our satisfactory outcomes may be explained by the stringent selection of recipients combined with regular follow-up.
['Bosseau|Christian|C|', 'Lelong|Bernard|B|', 'Pattier|Sabine|S|', 'Trochu|Jean-Noël|JN|', 'Roussel|Jean-Christian|JC|', 'Sirinelli|Agnès|A|', 'Aupart|Michel|M|', 'Chabanne|Céline|C|', 'Dorent|Richard|R|', 'Cantrelle|Christelle|C|', 'Mabo|Philippe|P|', 'Leclercq|Christophe|C|', 'Verhoye|Jean-Philippe|JP|', 'Flécher|Erwan|E|']
D000328:Adult D000368:Aged D005260:Female D006333:Heart Failure D016027:Heart Transplantation D006801:Humans D053208:Kaplan-Meier Estimate D008297:Male D008875:Middle Aged D012189:Retrospective Studies D016896:Treatment Outcome D055815:Young Adult
Heart transplantation Outcomes Elderly End-stage heart failure