Heart transplant recipients transplanted under age 55 survive longer-study.

Heart transplant patients who receive their new organ before age 55 and get them at transplant centers that perform at least nine a year are significantly more likely than other recipients to survive at least 10 years after their operation, according to a new study by researchers at Johns Hopkins Hospital.

Examining data from more than 22,000 Americans who received a new heart between 1987 and 1999, researchers found that roughly half were still alive a decade after being transplanted and further analysis identified factors that appear to predict at least 10 years of life after the operations.

Arman Kilic, MD, a surgical resident at The Johns Hopkins Hospital and leader of the study, said the research findings are very important because there are more than 2,000 to 2,500 heart transplants a year in the US and many people die on the waiting list, "We have to be very smart about how to allocate scarce organs, and our research suggests we can predict which patients will live longer with a new heart."

Kilic and his colleagues used information collected by the United Network for Organ Sharing (UNOS) and compared the 9,404 heart transplant recipients who survived for 10 or more years with the 10,373 who did not. The researchers found that:

* patients 55 or younger had a 24% greater chance of 10-year survival than older patients;

* those treated at hospitals performing nine or more heart transplants a year had a 31% greater chance of 10-year survival than those at lower volume centers;

* white patients were 35% more likely to survive a decade than minority patients.

* patients at high volume centers do better not only because their surgeons likely have more experience with heart transplants, but also because staff and facilities are likely better equipped to manage the complex post-operative care of the patients;

* patients who were on ventilators before their transplants were 47% more likely to die within 10-years of surgery;

* people who require breathing machines before surgery are much sicker than those who do not;

* people who had diabetes were one-third more likely to die within 10 years of transplant.

The study results also show the impact on long-term survival of ischemic time. For every hour ischemic time was reduced, the recipient has an 11% increase in the chance that they will survive a decade or more. In addition, for every decade younger the donor was, the recipient was 10% more likely to survive long term, Kilic said.

More than five million Americans suffer from heart failure, and while the majority of the patients can be managed with lifestyle modifications and medication, for those who suffer from severe, end-stage heart failure, heart transplantation remains the gold standard treatment.