Recipient age impact on outcome after cardiac transplantation: should it still be considered in organ allocation?
Improvement of clinical results in heart transplantation (HTx) has favoured the expansion of indication criteria towards aged population. The impact of increasing recipient age is controversial and, owing to donor shortage, the debate still remains whether HTx is justified for older patients. We analysed age as a prognostic factor at long-term after HTx and if it should be a determinant in organ allocation.



Data of 364 consecutive patients who underwent cardiac transplantation between 1999 and 2014 at the University Hospital of Udine were analysed. Patients were divided into three groups according to age (Group 1: 18-40, Group 2: 41-59, Group 3: ≥ 60 years) and survival and major complications were evaluated at long-term (mean follow-up 6.7 ± 4.5 years, range 1-15.7 years).



Preoperatively, renal failure (2.9, 16.1, 39.5%, P < 0.01) and cardiovascular factors such as diabetes (1.2, 17.1, 36.4%, P < 0.01), systemic hypertension (5.9, 31.5, 40.8%, P < 0.01) and dyslipidaemia (5.9, 40.3, 42.9%, P < 0.01) were more common in older patients (Group 3), as well as ischaemic cardiopathy (0, 42.6, 49.7%, P < 0.01). Donor age was lower in younger recipients (Group 1) (33 ± 15, 39 ± 14, 45 ± 14 years, P < 0.01). Older patients showed a worse long-term survival (hazard ratio 1.7; 1.1-2.5), also after adjusting for major cardiovascular risk factors, renal failure and donor age. In fact, 15-year survival was 100% in Group 1, while at 1, 5, 10 and 15 years survival was 88, 78, 69 and 56% in Group 2, and 87, 68, 49 and 43% in Group 3, respectively. Even major long-term complications were less frequent in younger patients in terms of neoplasms (P < 0.01), rehospitalizations (P < 0.01) and a tendency to higher freedom from other complications such as cytomegalovirus infections, renal failure and dialysis.



Our results showed a significantly different outcome according to recipient age, even when adjusted for major risk factors. Notably, patients younger than 40 years showed 100% long-term survival, and apparent lower rate of complications due to immunosuppression. Since 15-year survival in patients ≤40 years is twice that of patients ≥60 years, recipient age should be taken into account in organ allocation.
Department of Cardiothoracic, University Hospital of Udine, Udine, Italy sandro_sponga@yahoo.com.
Sandro
S
Sponga
Department of Cardiothoracic, University Hospital of Udine, Udine, Italy.
Laura
L
Deroma
Department of Cardiothoracic, University Hospital of Udine, Udine, Italy.
Roberta
R
Sappa
Department of Cardiothoracic, University Hospital of Udine, Udine, Italy.
Daniela
D
Piani
Department of Cardiothoracic, University Hospital of Udine, Udine, Italy.
Andrea
A
Lechiancole
Department of Cardiothoracic, University Hospital of Udine, Udine, Italy.
Enrico
E
Spagna
Department of Cardiothoracic, University Hospital of Udine, Udine, Italy.
Vincenzo
V
Tursi
Department of Cardiothoracic, University Hospital of Udine, Udine, Italy.
Chiara
C
Nalli
Department of Cardiothoracic, University Hospital of Udine, Udine, Italy.
Ugolino
U
Livi
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006084:Graft Rejection / Q000453:epidemiology*; D006333:Heart Failure / Q000401:mortality / Q000601:surgery*; D016027:Heart Transplantation / Q000401:mortality*; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D014019:Tissue Donors; D066027:Transplant Recipients; D055815:Young Adult
Heart transplantation; Organ allocation; Recipient age