Background
Risk-adjusted survival after late heart re-transplantation may be comparable to primary
transplant, but the efficacy of re-transplantation in older candidates is not established.
We evaluated outcomes after heart re-transplantation in recipients > 60 years.
Methods
We identified 1026 adult patients undergoing isolated heart re-transplantation between
2003 and 2020 from the United Network for Organ Sharing database. Older recipients
(> 60 years, n=177) were compared to younger recipients (≤ 60 years, n=849). Five
and ten-year post-transplant survival was estimated using the Kalpan-Meier method
and adjusted with multivariable Cox models.
Results
Older recipients were more likely to be male and have diabetes or previous malignancies
with higher baseline creatinine. They also more frequently required pre-transplant
ECMO (11.9% vs. 6.8%, p=0.02) and received re-transplantation due to primary graft failure (13.6% vs. 8.5%,
p=0.03). After the transplant, older recipients had a higher incidence of stroke (6.8%
vs. 2.6%, p=0.01) and dialysis requirements (20.3% vs. 13.2%) before discharge (both p<0.05), and more frequently died from malignancy-related causes (16.3% vs. 3.9%, p<0.001). After adjustment, recipient age >60 was associated with an increased risk
of both 5-year (HR 1.42, 95% CI 1.02-2.01, p=0.04) and 10-year mortality (HR 1.72, 95% CI 1.20-2.45, p=0.003). Restricted cubic spline showed a non-linear relationship between recipient
age and 10-year mortality.
Conclusions
Heart re-transplantation in recipients > 60 years has inferior outcomes compared to
younger recipients. Strict patient selection and close follow-up are warranted to
ensure the appropriate utilization of donor hearts and to improve long-term outcomes.
Keywords
Abbreviations:
ECMO (extracorporeal membrane oxygenation), eGFR (glomerular filtration rate), IQR (interquartile range), ISHLT (International society for heart and lung transplantation), MCS (mechanical circulatory support), PHM (predicated heart mass), UNOS (united network for organ sharing)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: December 06, 2022
Publication stage
In Press Journal Pre-ProofIdentification
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© 2022 International Society for Heart and Lung Transplantation. All rights reserved.
