Essay on Organ Transplant and Younger Patients

Submitted By neusha90
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On December 3, 1967 South African surgeon Christon Barnard conducted the first heart transplant on 53-year-old Lewis Washkansky. The surgery was a suceess. However, the medications that were given to Waskansky to prevent his immune system from attacking the new heart also supressed his body ability to fight off other illnessesillness. Eighteen days after the operation , Washkansky died of double pneumonia
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------------------------------------------------- Background. Advanced age has traditionally been considered a relative contraindication to heart transplantation because of the potential for increased morbidity and decreased long-term survival.

Methods. We analyzed the results in 40 patients 65 years of age and older who underwent heart transplantation and compared them with those in 138 patients younger than 65 years.

Results. The older age group had a higher incidence of diabetes mellitus (p = 0.01), donor-recipient weight mismatch (<0.80) (p = 0.004), lower donor-recipient weight ratio (p = 0.02), and longer allograft ischemic time (p = 0.008), among other differences. However, the 30-day operative mortality was similar in both groups (2.5% in older versus 2.2% in younger patients). Actuarial survival at 12, 24, and 36 months was not statistically different between the older and younger patients (86% ± 6% versus 93% ± 2%, 78% ± 8% versus 89% ± 3%, and 72% ± 9% versus 81% ± 4%, respectively; p = 0.26). The posttransplantation intensive care unit stay, total hospital stay, and associated hospital costs were also similar. The incidence of rejection during the first posttransplantation year was similar in both groups.

Conclusions. Heart transplantation in selected patients 65 years of age and older can be performed successfully, with a morbidity and mortality comparable with those seen in younger patients. Advanced age should not be an exclusion criterion for heart transplantation, but selective criteria should be applied that identify risks and benefits individually.
Despite many advances in heart transplantation over the past two decades, most transplant centers still consider advanced age a relative contraindication to cardiac transplantation. This is based on data showing that advanced age is a strong factor influencing short- and long-term survival [1].

As the elderly are becoming the fastest growing and largest segment of the United States population, the patterns of cardiac surgery practice are evolving. As evidence of this, more elderly people have been undergoing highly sophisticated open heart interventions at our institution, with an acceptable morbidity and mortality and improved quality of life [2]. Encouraged by this experience, and because of our success with heart transplantation in younger patients, we have extended the age criteria in selected patients with end-stage cardiomyopathy not amenable to further medical or surgical intervention. To analyze the impact of age as a risk factor after heart transplantation, we retrospectively reviewed our experience in patients 65 years of age and older who underwent cardiac transplantation and compared it with our experience in a younger cohort of patients.
Between December 1988 and December 1995, 178 patients underwent orthotopic heart transplantation at Cedars-Sinai Medical Center. The hospital records for 40 patients 65 years of age and older were compared with the records for 138 patients younger than 65 years.

The preoperative characteristics of both patient age groups are listed in Table 1. A higher incidence of diabetes mellitus (p = 0.01) and a greater preoperative left ventricular ejection fraction (p = 0.0002) in the older age group were the only statistically significant differences between the groups. Donor characteristics are given in Table 2.…