Long-term survival (>10 years) of patients >60 years with induction therapy after cardiac transplantation

Objective: Cardiac transplantation has become an established method for end-stage heart disease. Short- and mid-term outcome has been known to be similar between younger and older (>60 years) recipients. So far, nothing is known about long-term outcome of old patients and the potential long-term effects of antibody induction therapy in these patients. The purpose of this study was to analyse long-term outcome of old cardiac transplant recipients who underwent antibody induction therapy. Methods: Since 1989, 203 patients (total n=882) above 60 years have been transplanted at our center. On these patients n=66 were above 65 years. Survival, incidences of rejection, infection, cancer, graft arteriosclerosis and the amount of renal insufficiency were compared with patients 65 years were without steroid maintenance therapy (43.1%) compared to other patient groups (8.2 vs. 9.3%; P2.0 mg/dl) between the three groups (10 vs. 14 vs. 16%; P=NS). Conclusions: Old recipients of cardiac transplants have a similar long-term outcome than younger recipients. They were less prone to rejections, had a similar incidence of severe infections and showed a trend towards more CMV disease. All patients had a very low rate of graft arteriosclerosis that was similar amongst the groups. Age-related decline of the immune system further enhanced by immunomodulation of antibody induction therapy might be accounted for the results as well as steroid-free immunosuppression.