Survival Data Show Viability of Transplants in Older Patients

“I was rather surprised” by the 8-year value for the septuagenarians. “That's a very important number,” commented Dr. Goldstein.

“While survival is comparatively reduced, it still exceeds by a lot what we currently see with mechanical support therapy,” he said.

In a final analysis that was restricted to patients who survived the first year post transplantation, patients aged 70 years or older no longer had an increased risk of death, compared with their counterparts aged 60-69 years.

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Consider Ethics, Consequences

The boundaries of reasonable medical care are being pushed daily, and it now appears that heart transplantation can be done safely with acceptable survival in septuagenerians. Do these recipients receive the same posttransplant survival benefit as sexagenerians? Not quite, but it's pretty close. The small survival differences between the septuagenarians and sexagenerians suggest that age (and perhaps selection bias) should allow for older patients to be considered, in certain circumstances, as candidates. What sets organ transplantation apart from other heroic interventions (e.g., experimental chemotherapy for patients with metastatic cancer) is that donor organs are an exquisitely limited commodity. The ethics of increasing the recipient pool by including older patients must be considered, and this change may have significant consequences for younger patients on the wait list.

DR. SUDISH MURTHY is an ACS fellow and surgical director of the Center for Major Airway Disease at the Cleveland Clinic.

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