Factors associated with 5-year survival in older heart transplant recipients

Arman Kilic, Eric S. Weiss, David D. Yuh, Ashish S. Shah, John Conte

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Objectives: The aim of the present study was to identify the predictors of 5-year survival in elderly patients undergoing orthotopic heart transplantation (OHT). Methods: A review of the United Network for Organ Sharing database was conducted of recipients 60 years old or older undergoing OHT from 1995 to 2004. The variables were compared between the 5-year survivors and the patients who died within 5 years of OHT. A multivariate logistic regression model was constructed using the covariates significantly associated with 5-year survival on univariate analysis. Results: A total of 5330 elderly patients underwent OHT during the study period. Of these patients, 3492 (65.5%) were 5-year survivors, 1580 (29.6%) had died within 5 years of OHT and were considered controls, and 258 (4.8%) were lost to follow-up. The predictors of improved 5-year survival included younger age (odds ratio [OR], 0.97; 95% confidence interval [CI], 0.95-1.00; P = .03), lower creatinine (OR, 0.92; 95% CI, 0.87-0.98; P = .01), white race (OR, 1.23; 95% CI, 1.02-1.49; P = .03), shorter ischemic time (OR, 0.93; 95% CI, 0.87-0.99; P = .02), and younger donor age (OR, 0.99; 95% CI, 0.99-1.00; P = .03). The following significantly reduced the odds of surviving to 5 years: mechanical ventilation (OR, 0.48; 95% CI, 0.33-0.71; P < .001), hypertension (OR, 0.79; 95% CI, 0.69-0.91; P = .001), and diabetes (OR, 0.79; 95% CI, 0.67-0.92; P = .003). Ventricular assist device data were only available for 2538 patients (49.6%). When added to the multivariate model, the use of a ventricular assist device significantly reduced the odds of surviving 5 years after OHT (OR, 0.63; 95% CI, 0.50-0.81; P < .001). Conclusions: In the present study of more than 5000 elderly OHT patients, younger recipient age, white race, lower creatinine, younger donor age, and shorter ischemic time were associated with improved 5-year survival. In contrast, bridging with a ventricular assist device, mechanical ventilation, hypertension, and diabetes significantly decreased the odds of 5-year survival. These findings might be useful for prognostication in this higher risk patient population.

Original languageEnglish (US)
Pages (from-to)468-474
Number of pages7
JournalJournal of Thoracic and Cardiovascular Surgery
Volume143
Issue number2
DOIs
StatePublished - Feb 1 2012

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Heart Transplantation
Odds Ratio
Confidence Intervals
Survival
Heart-Assist Devices
Artificial Respiration
Survivors
Creatinine
Logistic Models
Tissue Donors
Hypertension
Transplant Recipients
Lost to Follow-Up
Databases
Population

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Kilic, Arman ; Weiss, Eric S. ; Yuh, David D. ; Shah, Ashish S. ; Conte, John. / Factors associated with 5-year survival in older heart transplant recipients. In: Journal of Thoracic and Cardiovascular Surgery. 2012 ; Vol. 143, No. 2. pp. 468-474.
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abstract = "Objectives: The aim of the present study was to identify the predictors of 5-year survival in elderly patients undergoing orthotopic heart transplantation (OHT). Methods: A review of the United Network for Organ Sharing database was conducted of recipients 60 years old or older undergoing OHT from 1995 to 2004. The variables were compared between the 5-year survivors and the patients who died within 5 years of OHT. A multivariate logistic regression model was constructed using the covariates significantly associated with 5-year survival on univariate analysis. Results: A total of 5330 elderly patients underwent OHT during the study period. Of these patients, 3492 (65.5{\%}) were 5-year survivors, 1580 (29.6{\%}) had died within 5 years of OHT and were considered controls, and 258 (4.8{\%}) were lost to follow-up. The predictors of improved 5-year survival included younger age (odds ratio [OR], 0.97; 95{\%} confidence interval [CI], 0.95-1.00; P = .03), lower creatinine (OR, 0.92; 95{\%} CI, 0.87-0.98; P = .01), white race (OR, 1.23; 95{\%} CI, 1.02-1.49; P = .03), shorter ischemic time (OR, 0.93; 95{\%} CI, 0.87-0.99; P = .02), and younger donor age (OR, 0.99; 95{\%} CI, 0.99-1.00; P = .03). The following significantly reduced the odds of surviving to 5 years: mechanical ventilation (OR, 0.48; 95{\%} CI, 0.33-0.71; P < .001), hypertension (OR, 0.79; 95{\%} CI, 0.69-0.91; P = .001), and diabetes (OR, 0.79; 95{\%} CI, 0.67-0.92; P = .003). Ventricular assist device data were only available for 2538 patients (49.6{\%}). When added to the multivariate model, the use of a ventricular assist device significantly reduced the odds of surviving 5 years after OHT (OR, 0.63; 95{\%} CI, 0.50-0.81; P < .001). Conclusions: In the present study of more than 5000 elderly OHT patients, younger recipient age, white race, lower creatinine, younger donor age, and shorter ischemic time were associated with improved 5-year survival. In contrast, bridging with a ventricular assist device, mechanical ventilation, hypertension, and diabetes significantly decreased the odds of 5-year survival. These findings might be useful for prognostication in this higher risk patient population.",
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Factors associated with 5-year survival in older heart transplant recipients. / Kilic, Arman; Weiss, Eric S.; Yuh, David D.; Shah, Ashish S.; Conte, John.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 143, No. 2, 01.02.2012, p. 468-474.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Factors associated with 5-year survival in older heart transplant recipients

AU - Kilic, Arman

AU - Weiss, Eric S.

AU - Yuh, David D.

AU - Shah, Ashish S.

AU - Conte, John

PY - 2012/2/1

Y1 - 2012/2/1

N2 - Objectives: The aim of the present study was to identify the predictors of 5-year survival in elderly patients undergoing orthotopic heart transplantation (OHT). Methods: A review of the United Network for Organ Sharing database was conducted of recipients 60 years old or older undergoing OHT from 1995 to 2004. The variables were compared between the 5-year survivors and the patients who died within 5 years of OHT. A multivariate logistic regression model was constructed using the covariates significantly associated with 5-year survival on univariate analysis. Results: A total of 5330 elderly patients underwent OHT during the study period. Of these patients, 3492 (65.5%) were 5-year survivors, 1580 (29.6%) had died within 5 years of OHT and were considered controls, and 258 (4.8%) were lost to follow-up. The predictors of improved 5-year survival included younger age (odds ratio [OR], 0.97; 95% confidence interval [CI], 0.95-1.00; P = .03), lower creatinine (OR, 0.92; 95% CI, 0.87-0.98; P = .01), white race (OR, 1.23; 95% CI, 1.02-1.49; P = .03), shorter ischemic time (OR, 0.93; 95% CI, 0.87-0.99; P = .02), and younger donor age (OR, 0.99; 95% CI, 0.99-1.00; P = .03). The following significantly reduced the odds of surviving to 5 years: mechanical ventilation (OR, 0.48; 95% CI, 0.33-0.71; P < .001), hypertension (OR, 0.79; 95% CI, 0.69-0.91; P = .001), and diabetes (OR, 0.79; 95% CI, 0.67-0.92; P = .003). Ventricular assist device data were only available for 2538 patients (49.6%). When added to the multivariate model, the use of a ventricular assist device significantly reduced the odds of surviving 5 years after OHT (OR, 0.63; 95% CI, 0.50-0.81; P < .001). Conclusions: In the present study of more than 5000 elderly OHT patients, younger recipient age, white race, lower creatinine, younger donor age, and shorter ischemic time were associated with improved 5-year survival. In contrast, bridging with a ventricular assist device, mechanical ventilation, hypertension, and diabetes significantly decreased the odds of 5-year survival. These findings might be useful for prognostication in this higher risk patient population.

AB - Objectives: The aim of the present study was to identify the predictors of 5-year survival in elderly patients undergoing orthotopic heart transplantation (OHT). Methods: A review of the United Network for Organ Sharing database was conducted of recipients 60 years old or older undergoing OHT from 1995 to 2004. The variables were compared between the 5-year survivors and the patients who died within 5 years of OHT. A multivariate logistic regression model was constructed using the covariates significantly associated with 5-year survival on univariate analysis. Results: A total of 5330 elderly patients underwent OHT during the study period. Of these patients, 3492 (65.5%) were 5-year survivors, 1580 (29.6%) had died within 5 years of OHT and were considered controls, and 258 (4.8%) were lost to follow-up. The predictors of improved 5-year survival included younger age (odds ratio [OR], 0.97; 95% confidence interval [CI], 0.95-1.00; P = .03), lower creatinine (OR, 0.92; 95% CI, 0.87-0.98; P = .01), white race (OR, 1.23; 95% CI, 1.02-1.49; P = .03), shorter ischemic time (OR, 0.93; 95% CI, 0.87-0.99; P = .02), and younger donor age (OR, 0.99; 95% CI, 0.99-1.00; P = .03). The following significantly reduced the odds of surviving to 5 years: mechanical ventilation (OR, 0.48; 95% CI, 0.33-0.71; P < .001), hypertension (OR, 0.79; 95% CI, 0.69-0.91; P = .001), and diabetes (OR, 0.79; 95% CI, 0.67-0.92; P = .003). Ventricular assist device data were only available for 2538 patients (49.6%). When added to the multivariate model, the use of a ventricular assist device significantly reduced the odds of surviving 5 years after OHT (OR, 0.63; 95% CI, 0.50-0.81; P < .001). Conclusions: In the present study of more than 5000 elderly OHT patients, younger recipient age, white race, lower creatinine, younger donor age, and shorter ischemic time were associated with improved 5-year survival. In contrast, bridging with a ventricular assist device, mechanical ventilation, hypertension, and diabetes significantly decreased the odds of 5-year survival. These findings might be useful for prognostication in this higher risk patient population.

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