NEW ORLEANS, Nov. 13 – The elderly are good candidates for heart transplants and can benefit from hearts that might be unsuitable for younger people, researchers report today at the American Heart Association’s Scientific Sessions 2000.
Each year it is estimated that 20,000 to 40,000 Americans would benefit from a heart transplant. However, in 1998, only 2,340 heart transplants were performed in the United States due to a shortage of suitable donor organs. In the United States, 52 percent of heart transplant patients are ages 50-64. As the population ages, more elderly individuals will need heart transplants.
Researchers at UCLA Medical Center may have found a way to increase the supply of usable donor hearts by implementing a dual list for the organs, says Daniel Marelli, M.D., co-author of the study and an assistant professor of cardiac surgery at UCLA. The team of physicians and surgeons was led by Dr. Hillel Laks.
Under UCLA’s program, patients 65 and younger are placed on the standard waiting list with younger patients. Those who are 70 or older are placed on an alternate list for hearts that might not be acceptable for younger patients. For instance, a heart donated from someone with coronary disease may still have good function, but need minor repair. It would be unacceptable for a 15-year-old, Marelli says, but would be a workable solution for an older patient.
Those who are ages 65-70 are placed on both lists.
“There is a difference in survival goals between the younger and older patients,” Marelli says. “While in a younger patient a goal of greater than 10-15 years of life may be attainable, the outcomes in an older person after seven to eight years are not as certain and are related to non-cardiac issues. By sorting potential recipients by age, transplant centers can save lives among older transplant candidates, use donor hearts that might otherwise be unused in younger patients, and make sure that hearts suitable for younger individuals are not diverted away from them.
“Elderly people do well with heart transplantation, and we shouldn’t exclude them because of their age,” Marelli says. “We’re trying to salvage some of these hearts and match them to people in whom they would be acceptable,” he says.
“Two-thirds of such salvaged ‘marginal’ hearts are used in younger people at risk of imminent death,” Marelli says. “However, when we cannot find such a match, we offer them to older patients on an ‘alternate’ list.”
In a review of 175 patients 62 years or older, 54 were placed on an alternate waiting list. Most had end-stage cardiomyopathy, a serious disease in which the heart muscle becomes weak and doesn’t pump enough blood to the body.
For the group on the standard list, survival was 92 percent at 30 days following transplant and 72 percent five years after the operation. For the alternate group, survival was 90 percent at 30 days and 78 percent at four years.
“Using a dual-listing strategy may allow for heart transplant in the elderly without limiting the supply of organs for others,” the team concludes.
The elderly patients receiving the transplants reported being “very satisfied,” and said they were able to go back to normal activities, such as leisure pursuits, travel and even work for some, Marelli says. The argument persists that the elderly shouldn’t receive transplants at all, but Marelli said his elderly patients do as well as younger ones in a number of areas. There is no difference in recovery time; and survival rates at five years also are “comparable and sustained.” In addition, older people experience less transplant rejection, therefore requiring less immunosuppressant drugs; this may explain why they are able to tolerate the procedure as well as young people do.
New treatments are being developed that may make a difference for all heart transplant patients. For this reason, it is difficult to predict how current transplant patients will be faring 10 years from now.
Co-authors are Michele A. Hamilton, Gregg C. Fonarow, Daniel Fazio, Jamie D. Moriguchi, Saleh Saleh, Bernard Kubak, Abbas Ardehali, Fardad Esmailian, Antoine Hage and Jon A. Kobashigawa.
NR00-1183 (SS2000/Marelli)