Posttransplant Outcomes Among Septuagenarians Bridged to Transplantation With Continuous-Flow Left Ventricular Assist Devices

Background: A bridge to transplant strategy with a continuous-flow left ventricular assist device is increasingly being offered to older patients. However, the upper patient age limit has not been defined.

Methods: The United Network of Organ Sharing (UNOS) database was used to identify 21,258 heart transplant recipients from 2004 to 2014. Of these, 4,850 (22.8%) were bridged with a continuous-flow left ventricular assist device. Recipients were stratified by age: group 1, aged 70 years or more (n = 115, 2.4%); and group 2, aged 18 to 69 years (n = 4,735, 97.6%).

Results: Elderly patients more likely had ischemic etiology than younger patients (69.6% versus 41.0%; p < 0.001), and received a heart from an older donor (35.8 versus 31.3 years, p < 0.001) or an expanded criteria donor (8.7% versus 2.4%; p < 0.001). Elderly patients had decreased 90-day survival (88.8% versus 93.2%; p = 0.021) and 3-year posttransplant survival (80.9% versus 85.7%; p = 0.073). However, analysis of a propensity matched cohort did not demonstrate survival difference at 90 days and 3 years. Among septuagenarians, the model for end-stage liver disease excluding international normalized ratio (MELD-XI) score was a predictor for 90-day mortality (hazard ratio 4.48, 95% confidence interval: 1.90 to 10.55; p = 0.001) and 3-year mortality (hazard ratio 2.27, 95% confidence interval: 1.51 to 3.41; p < 0.001), whereas functional independence was protective for 3-year mortality (hazard ratio 0.11, 95% confidence interval: 0.013 to 0.86; p = 0.036). Functionally independent patients showed a remarkably superior posttransplant survival compared with functionally dependent patients (96.7% versus 42.8% at 3 years; p = 0.001).

Conclusions: The continuous-flow left ventricular assist device supported septuagenarians did not have increased posttransplant mortality. Functional outcomes during device support may have important implications for organ allocation among the elderly.