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Inicio Revista Española de Geriatría y Gerontología El trasplante cardíaco en pacientes añosos
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Vol. 37. Issue 1.
Pages 32-36 (January 2002)
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Vol. 37. Issue 1.
Pages 32-36 (January 2002)
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El trasplante cardíaco en pacientes añosos
Heart transplantation in patients elderly
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L. Almenar Bonet
Corresponding author
lu.almenarb5@comv.es

Correspondencia: Avd. Primado Reig 189-37. 46020 Valencia.
Servicio de Cardiología. Hospital Universitario La Fe. Valencia. Subanálisis del Registro Español de Trasplante Cardíaco
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Introduccion

La edad avanzada ha sido considerada clasicamente como una contraindicacion formal para el trasplante cardiaco (TC). Ello ha sido debido, por un lado, al presunto incremento de la morbilidad y mortalidad de esta tecnica a mediada que aumenta la edad de los pacientes, y por otro, a disponer de un numero de organos limitado.

Objetivo

Analizar las caracteristicas diferenciales de los pacientes trasplantados utilizando como punto de corte 65 años

Material y método

En España existe un registro de todos los TC realizados que se actualiza periódicamente una vez al año. El presente análisis se ha realizado sobre los datos de los primeros 1.722 trasplantes recibidos para el registro de 1984–2000 (el total comprende 3.445 trasplantes). Exclusión: TC en menores de 18 años, retrasplantes, TC combinados y heterotópicos. El analisis final fue sobre 1538 TC (87 ≥ 65 años). Variables analizadas: Situación previa al TC, Características de los donantes, número de rechazos e infecciones, desarrollo de factores de riesgo en el seguimiento, causas de mortalidad y análisis de la supervivencia. Estadística: Se consideró significativo una p < 0,05. Se han utilizado los tests T Student, χ2, Kaplan-Meier y Log rank.

Resultados

Los pacientes mayores presentan de forma significativa: antecedentes cardiopatia isquemica, mejor situacion clinica pretrasplante (menos disfuncion hepatica, necesidad de inotropos, ventilacion mecanica y urgencias), fallo agudo del injerto, desarrollo de hipertension arterial y complicaciones neurologicas, menos rechazos. La probabilidad de supervivencia tambien es distinta (supervivencia al 1er, 3.° y 7.° ano: ≥ 65 años, 66, 60 y 11% vs < 65 años, 76, 68 y 57%; p < 0,05).

Conclusiones

La importante limitacion en el modo de incluir pacientes de este estudio, no permite hacer conclusiones categoricas. No obstante, y aunque no es deseable contraindicar un TC atendiendo exclusivamente a la edad real, parece bastante claro el hecho de que los pacientes ≥ 65 años poseen una mayor morbi-mortalidad.

Palabras clave:
Trasplante cardíaco
Edad avanzada
Morbilidad
Mortalidad
Introduction

Advanced age has traditionally been considered to be a definite contraindication for heart transplantation (HT). On the one hand, this is due to the presumed increase in the morbidity and mortality of this technique as real age increases, and, on the other hand, to the limited number of organs available.

Objective

To analyze the differential characteristics of transplant recipients using an age cutoff point of 65 years.

Material and Method

In Spain there is a registry of all HT performed, which is updated once a year. The present analysis was performed on the data of the first 1,772 transplants received for the 1984-2000 registry (a total of 3,445 transplants).

Exclusion

HT in persons under 18 years, re-transplantations, combined and heterotopic HT. A total of 1,538 HT were included (87 ≥ 65 years) in the final analysis. Variables analyzed: Situation before HT donor characteristics, number of rejections and infections, development of risk factors during follow-up, causes of death, and survival analysis. Statistics: A p < 0.05 was considered significant. The Student’s t, chi-square, Kaplan-Meier, and log-rank tests were used.

Results

Older patients had a significantly greater frequency of: ischemic heart disease history, better-pre-transplantation clinical situation (less liver dysfunction, need for inotropic agents, mechanical ventilation and emergencies), acute graft failure, development of high blood pressure and neurological complications fewer rejections. The probability of survival also differed (survival at 1, 3, and 7 years:≥ 65 years, 66, 60, and 11% vs < 65 years, 76, 68, and 57%; p < 0.05).

Conclusions

The significant limitation in the mode of including patients in this study does not allow categorical conclusions to be drawn. However, although it is undesirable to contraindicate HT based solely on age, it seems fairly clear that patients ≥ 65 years have more morbidity and mortality.

Key words:
Heart transplant
Elderly
Morbidity
Mortality
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Copyright © 2002. Sociedad Española de Geriatría y Gerontología
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