At 5 years, survival rates after heart transplant were noninferior in older patients compared with younger patients, according to new data published in the Journal of the American Geriatrics Society.
“An investigation of the United Network of Organ Sharing database observed that despite advanced age and less ideal donors, recipients in their 70s had similar post-heart transplant outcomes to recipients in their 60s,” Abhishek Jaiswal, MD, a consultant for advanced heart failure treatment and heart transplant at Hartford Healthcare Heart and Vascular Institute at Hartford Hospital, and colleagues wrote. “However, little is known regarding trends and outcomes for older patients who are listed for heart transplant in the United States in the contemporary era.”
For the retrospective cohort analysis, the researchers evaluated 57,285 patients listed for heart transplantation in the Scientific Registry of Transplant Recipients (SRTR) database from 2000 to 2018. Of these, 37,135 patients underwent heart transplantation, 2.2% of whom were aged 70 years or older. Researchers compared characteristics and outcomes for those aged 70 years or older and those younger than 70 years, and assessed waitlist mortality and posttransplant 1- and 5-year survivals.
There were consistent increases in yearly listing of individuals aged 70 years or older, from 2.5% in 2000 to 11% in 2017 (P < .01). Patients aged 70 years or older demonstrated similar risk for death while on transplant waitlists, with 8.6% compared with 10.1% among patients younger than 70 years (sub-HR = 0.86; 95% CI, 0.68-1.08; P = .19). Older patients were also more likely to undergo heart transplantation (sub-HR = 1.36; 95% CI, 1.26-1.48; P < .01).
In the older patients, at 1 year, the mortality rate was 10.4%, and at 5 years, it was 19.2%. In addition, older heart transplant recipients had lower unadjusted survival compared with younger heart transplant recipients (P = .03).
However, after adjusting for relevant covariates, researchers observed no significant difference in 5-year mortality between older and younger heart transplant recipients (HR = 1.06; 95% CI, 0.91-1.254; P = .43).
“Our findings suggest that chronologic age alone should not constitute a contraindication for heart transplant, although careful patient selection criteria should be applied considering donor shortage in the current era,” the researchers wrote. “However, considerations should be given to expanding donor pool size within currently available organs to counter donor shortage. Education against selection bias and early referral could improve the number of heart transplants and outcomes of older patients.”
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