Abstract 15555: Survival of Older Heart Transplant Recipients Bridged with LVAD Support
Background: The association of age with long-term outcomes after heart transplant (HT) is well known. However, age differences among patients bridged with LVAD have not been well-described. We therefore sought to examine the association of age with mortality in this population.
Methods: 3011 HT recipients bridged with LVAD (exclusions: age < 18y & multiorgan transplant) were identified from UNOS (2005-2011) & stratified by age (18-64y vs ≥ 65y). Survival was censored at 5y. Multivariate Cox proportional hazards regression analysis was adjusted for sex, diabetes (DM), ischemic time, ethnicity, dialysis, life support, wait time & HLA mismatch.
Results: There were 11.7% patients (pts) ≥ 65y. Pts ≥ 65y were more likely to have ischemic cardiomyopathy than pts <65y (63.0% vs 37.5, p < 0.0001), more likely to be male, & more commonly had history of COPD (Table). This group was more likely to have DM, worse renal function, lower BMI & less cardiovascular death. The proportion of older pts bridged with LVAD increased by year (5.2% in 2005 vs 16.9% in 2011, p < 0.0001). Survival (1, 3, 5y) was: ≥ 65y (81, 77, 69%) & 18-64y (88, 80, 73%) (Figure, log rank p=0.006). Unadjusted HR for all-cause mortality in pts ≥65 was 1.43 (CI 1.10-1.84, p = 0.009). Multivariable analysis yielded a HR 1.39 (CI 1.04-1.84, p < 0.0001).
Conclusion: Survival of older HT recipients bridged with LVAD is diminished though approaching that of the younger pts in this cohort. Early mortality was noted in the older population. Mortality in the older population was associated with increased co-morbidities. Further study is warranted to understand the survival differences with inherent implications for patient selection.
- © 2012 by American Heart Association, Inc.