Relation of Age to Risk of Major Rejections, Allograft Vasculopathy, and Long-Term Mortality in a Contemporary Cohort of Patients Undergoing Heart Transplantation.

Background:

In 2006, the ISHLT guidelines liberated and the upper age limit of heart transplantation (HTx) from 55-years to up to 70-years, and beyond for carefully selected patients. However, the relationship of age to outcomes following of HTx has not been well studied with inconsistent results. We aimed to investigate the impact of recipient’s age on the occurrence of rejections, vasculopathy, and mortality during long-term follow-up after HTX.

Methods :

Study population comprised all consecutive 291 patients who underwent HTx between 1991-2016 and are followed-up at our center. Patients were categorized by age tertiles:

Results:

Patients aged>57-years were more males and had more pre-HTx comorbidities including hypertension, diabetes, dyslipidemia and history of smoking (p<0.05) in comparison to the younger age-groups. Kaplan-Meier survival analysis by age tertiles showed the rates of major rejections and CAV at 15 years of follow-up were similar among the 3 age-groups (Figure 1; right and left panel, respectively). Mortality rates at 15 years were directly related to the age-groups (39%, 52%, 62% log-rank p-value=0.01). However, the association between age and mortality was no longer statistically significant after multivariate analysis (HR=1.01[95%CI 1.00-1.03] per 1-year age increment). Results were consistent among patients who received HTX in more recent years (2008-2016).

Conclusions: Our findings suggest that, in a contemporary cohort of patients undergoing HTX, the recipient’s age does not significantly impact the risk of major rejections, CAV, and long-term mortality.