[논문]Heart Transplantation in the Elderly Patients: Midterm Results

Yeom, Sang Yoon; Hwang, Ho Young; Oh, Se-Jin; Cho, Hyun-Jai; Lee, Hae-Young; Kim, Ki-Bong

doi:10.5090/kjtcs.2013.46.2.111

Heart Transplantation in the Elderly Patients: Midterm Results 원문보기

The Korean journal of thoracic and cardiovascular surgery, v.46 no.2, 2013년, pp.111 - 116

Yeom, Sang Yoon (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine) , Hwang, Ho Young (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine) , Oh, Se-Jin (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine) , Cho, Hyun-Jai (Cardiovascular Center and Cardiovascular Research Institute, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine) , Lee, Hae-Young (Cardiovascular Center and Cardiovascular Research Institute, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine) , Kim, Ki-Bong (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine)

Abstract ▼ AI-Helper

Background: Heart transplantation in elderly patients has raised concerns because of co-morbidities and limited life expectancy in the era of donor shortage. We examined the outcomes after heart transplantation in elderly patients. Materials and Methods: From March 1994 to December 2011, 81 patients (male:female=64:17, $49.1{\pm}14.0$ years) underwent heart transplantation. The outcomes after heart transplantation in the younger patients (<60 years; group Y, n=60) were compared with those in the elderly patients (${\geq}60$ years; group O, n=21). The follow-up duration was $51.8{\pm}62.7$ months. Results: Early mortality (${\leq}30$ days) occurred in 5.0% (3/60) and 4.8% (1/21) of groups Y and O, respectively (p>0.999). There were no differences in overall survival between the two groups (p=0.201). Freedom from rejection was higher in group O than in group Y (p=0.026). Multivariable analysis revealed that age ${\geq}60$ years was not a significant risk factor for long-term survival; postoperative renal failure was the only significant risk factor for long-term survival (p=0.011). Conclusion: Early and mid-term results of heart transplantation in elderly patients were similar to those in younger patients.

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문제 정의

The aim of this study was to evaluate early- and mid-term results of heart transplantation in patients ≥60 years old when compared with those of heart transplantation in patients ＜60 years old.

제안 방법

The patients underwent endomyocardial biopsy weekly for 4 weeks after transplantation, every 4 weeks until the third month, and then every 3 months until the second year. Rejection severity was graded from 0 to 4 based on the International Society for Heart and Lung Transplantation (ISHLT) grading system [10].
The patients underwent regular postoperative follow-up through the outpatient clinic at 3-month or 4-month intervals. The patients were also contacted by telephone for confirmation of their condition if the last clinic visit was not conducted at the scheduled time.

데이터처리

Comparisons between the two groups were performed using the chi-squared or Fisher’s exact test for categorical variables and the Student’s t-test for continuous variables.
Comparisons between the two groups were performed using the chi-squared or Fisher’s exact test for categorical variables and the Student’s t-test for continuous variables. Survival rates were estimated using the Kaplan-Meier method and comparisons between the 2 groups were performed using the log-rank test. The Cox proportional hazards model was adopted for analysis of risk factors for time related events.

성능/효과

First, there were no significant differences in the early results and mid-term survival between the elderly patients (≥60 years) and young patients (＜60 years) at the time of transplantation.

참고문헌 (17)

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3 Demers P Moffatt S Oyer PE Hunt SA Reitz BA Robbins RC Long-term results of heart transplantation in patients older than 60 years J Thorac Cardiovasc Surg 2003 126 224 231 12878959

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7 Sarsam MA Campbell CS Yonan NA Deiraniya AK Rahman AN An alternative surgical technique in orthotopic cardiac transplantation J Card Surg 1993 8 344 349 8507963

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8 Lower RR Shumway NE Studies on orthotopic homotransplantation of the canine heart Surg Forum 1960 11 18 19 13763847

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9 Taylor DO Cardiac transplantation: drug regimens for the 21st century Ann Thorac Surg 2003 75 6 Suppl S72 S78 12820738
10 Billingham ME Cary NR Hammond ME The International Society for Heart Transplantation A working formulation for the standardization of nomenclature in the diagnosis of heart and lung rejection: Heart Rejection Study Group J Heart Transplant 1990 9 587 593 2277293
11 Stehlik J Edwards LB Kucheryavaya AY The registry of the International Society for Heart and Lung Transplantation: twenty-eighth adult heart transplant report 2011 J Heart Lung Transplant 2011 30 1078 1094 21962016

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12 Robin J Ninet J Tronc F Long-term results of heart transplantation deteriorate more rapidly in patients over 60 years of age Eur J Cardiothorac Surg 1996 10 259 263 8740062
13 Borkon AM Muehlebach GF Jones PG An analysis of the effect of age on survival after heart transplant J Heart Lung Transplant 1999 18 668 674 10452343

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14 Fonarow GC How old is too old for heart transplantation? Curr Opin Cardiol 2000 15 97 103 10963146

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15 Robbins RC Ethical implications of heart transplantation in elderly patients J Thorac Cardiovasc Surg 2001 121 434 435 11241077

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16 Baron O Trochu JN Treilhaud M Cardiac transplantation in patients over 60 years of age Transplant Proc 1999 31 75 78 10083014

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17 Renlund DG Gilbert EM O'Connell JB Age-associated decline in cardiac allograft rejection Am J Med 1987 83 391 398 3310619

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DOI : 10.5090/kjtcs.2013.46.2.111 [무료]
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