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Senior Citizen Health & Medicine
Older Men and Women Now Eligible for Heart
Transplants Under New Guidelines
Older patients have qood survival rates,
less rejection problems
September 15, 2006 - Elderly men and women with
heart failure and men with treated prostate cancer are among those who
have been historically denied heart transplantation. Now, under new
guidelines co-authored by a Hopkins cardiologist and issued today by the
International Society for Heart and Lung Transplantation, they can and
should be considered. Research has shown many people, even into their
70s, have good survival rates and, surprisingly, appear to have less
rejection of the transplanted heart.
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People who once would die because they did not
qualify now have a chance to get a new heart, says Stuart Russell,
M.D., who served on the ISHLT committee revising the guidelines.
Research now suggests they are actually good
candidates, he adds.
ISHLT guidelines, which date back to 1992 and were
last updated in 1997, restricted access for cancer patients who been
tumor free for less than five years or had weakened immune systems from
cancer therapy that precluded them from taking anti-rejection drugs for
a transplanted organ.
The new recommendations raise the qualifying age
from 65 to 70 and allow some people with
slow-growing or treated cancers to qualify.
Support for the new criteria, says Russell, comes
from research confirming that transplant recipients over age 65 have a
90 percent survival rate one year post-transplant. After 10 years, he
says, 50 percent are still alive.
Advances in post-transplant care have made possible
improved outcomes in older patients over 60 and many centers have
demonstrated survival in older age groups comparable to that of younger
transplant patients and they tend to have fewer rejection episodes than
younger people.
A 10-year follow-up of cardiac transplant
recipients over 65 years of age demonstrated survival rates comparable
to those of younger patients. The ten-year survival was similar in all
groups:
● under 60 years: 53.7%;
● 60 to 64 years: 53.1%;
● over 65 years: 60.2%.
Most important, there were significantly fewer
rejection episodes in the older patient group:
● under 60 years: 74.9%;
● 60 to 64 years: 83.5%;
● over 65 years: 90.6%.
Patients over 70 years of age have also been
reported to have acceptable outcomes. In a study of 15 patients over and
under 70 years of age, the actuarial survival rates at 1 year and 4
years were not statistically different between older and younger
patients.
Patients over 70 years of age who meet specific
criteria may also be considered for cardiac transplantation, according
to the new recommendations.
Additional good news is that treating these older
patients will not likely use hearts that would have gone to younger
patients. Allocation of donor hearts to older patients can be managed
through the use of an alternate strategy where organs from donors -
usually older donors - that would otherwise remain unused are allocated
to older recipients.
Too often, people suffering from heart failure
and cancer give up on the prospect of a long, productive life, thinking
they have exhausted all treatment options possible, and even their
primary physicians are not aware that transplantation is a viable
option, says Russell, an associate professor at The Johns Hopkins
University School of Medicine and its Heart Institute.
Russell has been personally involved in the care of
more than 360 heart transplantation patients, including 13 at Hopkins so
far in 2006 and another 18 in 2005. He began work on revising the
guidelines at the April 2005 annual meeting of the ISHLT.
The expanded criteria follow changes in 2002
guidelines for organ donation, which permitted transplantation of hearts
from those over 50, even when the hearts were enlarged or the arteries
feeding it were clogged, provided the clot was removed. And they are
likely to increase demand for already scarce donor organs.
As of Sept. 1, at least 2,885 Americans were on
waiting lists for a heart transplant, according to the latest figures
from the United Network for Organ Sharing, the international
coordinating body that impartially distributes donated organs. Up to 20
percent of those on the list to receive a heart will die while waiting,
Russell notes.
The guidelines, posted at
http://www.ishlt.org,
reaffirm the organizations view that demand for transplantations is
unlikely to ever be fully met and that more resources are needed to slow
down the progression of heart failure and prevent the need for
transplant surgery in the first place.
Russell says new drugs, implantable defibrillators
and pacemakers, and smaller heart pumps can assist a weakened heart for
longer periods, or until a donor new organ becomes available.
He estimates that the relaxed guidelines could
result in up to 15 more heart transplantations for patients in the
region served by Hopkins in southeastern Pennsylvania, Maryland and
northern Virginia, none of whom would have qualified for an organ under
the old restrictions. Nationally, he estimates, up to 400 more patients
could now qualify and receive a new heart.
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