Factors associated with 5-year survival in older heart transplant recipients

ObjectivesThe aim of the present study was to identify the predictors of 5-year survival in elderly patients undergoing orthotopic heart transplantation (OHT).MethodsA review of the United Network for Organ Sharing database was conducted of recipients 60 years old or older undergoing OHT from 1995 to 2004. The variables were compared between the 5-year survivors and the patients who died within 5 years of OHT. A multivariate logistic regression model was constructed using the covariates significantly associated with 5-year survival on univariate analysis.ResultsA total of 5330 elderly patients underwent OHT during the study period. Of these patients, 3492 (65.5%) were 5-year survivors, 1580 (29.6%) had died within 5 years of OHT and were considered controls, and 258 (4.8%) were lost to follow-up. The predictors of improved 5-year survival included younger age (odds ratio [OR], 0.97; 95% confidence interval [CI], 0.95–1.00; P = .03), lower creatinine (OR, 0.92; 95% CI, 0.87–0.98; P = .01), white race (OR, 1.23; 95% CI, 1.02–1.49; P = .03), shorter ischemic time (OR, 0.93; 95% CI, 0.87–0.99; P = .02), and younger donor age (OR, 0.99; 95% CI, 0.99–1.00; P = .03). The following significantly reduced the odds of surviving to 5 years: mechanical ventilation (OR, 0.48; 95% CI, 0.33–0.71; P < .001), hypertension (OR, 0.79; 95% CI, 0.69–0.91; P = .001), and diabetes (OR, 0.79; 95% CI, 0.67–0.92; P = .003). Ventricular assist device data were only available for 2538 patients (49.6%). When added to the multivariate model, the use of a ventricular assist device significantly reduced the odds of surviving 5 years after OHT (OR, 0.63; 95% CI, 0.50–0.81; P < .001).ConclusionsIn the present study of more than 5000 elderly OHT patients, younger recipient age, white race, lower creatinine, younger donor age, and shorter ischemic time were associated with improved 5-year survival. In contrast, bridging with a ventricular assist device, mechanical ventilation, hypertension, and diabetes significantly decreased the odds of 5-year survival. These findings might be useful for prognostication in this higher risk patient population.