Ann Thorac Surg 2008;85:2055-2056. doi:10.1016/j.athoracsur.2008.02.079
© 2008 The Society of Thoracic Surgeons
Original Articles: Adult Cardiac
Invited Commentary
Michel Carrier, MD, FRCSC
Department of Surgery, Montreal Heart Institute, 5000 Belanger St E, Montreal, PQ, Canada H1T 1C8
(Email: michel.carrier{at}icm-mhi.org).
Indications for heart transplantation remain a matter of debate because potential recipients awaiting heart transplantation outnumber donors available during a single year. Several authors have supported the practice of listing older recipients for heart transplantation with satisfactory results.
The present publication of Tjang and colleagues [1] analyzed the long-term survival of patients who underwent heart transplantation in a single center experience. The authors demonstrated a lower rate of survival up to 15 years after surgery in recipients aged 55 years and older compared with younger patients at the time of transplantation. A clear difference for recipient's age on the outcomes after heart transplantation was showed, the relative risk of mortality increased 25% for recipient's age category of 55 to 65 years and 58% for recipients older than 66 years.
The authors concluded on a cautious note on listing older candidates for heart transplantation because of less favorable short-term and long-term outcomes in these age categories confronted with the scarcity of donor hearts. In other words, the true question is should we keep donor hearts for younger recipients?
The answer to the latter question is available in the report of the registry of the International Society for Heart and Lung Transplantation [2]. Currently, 25% of recipients for heart transplantation are 60 years and older. The Registry also shows that recipient's age (older than 55 years) is a constant risk factor for mortality up to 15 years after transplantation, a similar conclusion.
Although we understand that older recipients as a group have a higher risk of early and late mortality after heart transplantation, the final decision to list a patient for heart transplantation remains in the hands of a physician and his patient. Short of an effective long-term mechanical device, the only solution is to expand the donor pool by careful assessment and optimal use of marginal donors [3]. Balancing the older recipient's increased risks and the potential benefit of marginal donors while obtaining overall good clinical results remains the responsibility of each transplant's physicians and programs.
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References
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- Tjang YS, van der Heijden GJMG, Tenderich G, Körfer R, Grobbee DE. Impact of recipient's age on heart transplantation outcome Ann Thorac Surg 2008;85:2051-2056.[Abstract/Free Full Text]
- Taylor DO, Edwards LB, Boucek MM, et al. Registry of the International Society for Heart and Lung Transplantation: Twenty-fourth official adult heart transplant report—2007 J Heart Lung Transplant 2007;26:769-781.[Medline]
- Rosengard BR, Feng S, Alfrey EJ, et al. Report of the Crystal City meeting to maximize the use of organs recovered from cadaver donor Am J Transplant 2002;2:701-711.[Medline]
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