Elderly Heart Transplant Patients Have 5-Year Survival Similar to Younger Recipients

(Reuters Health) – Survival of elderly heart transplant recipients at five years is similar to that of younger recipients even though older adults are more likely to get organs from higher-risk donors, a recent study suggests.

Researchers examined data on 57,285 adults listed for heart transplantation from 2000 to 2018, including 1,203 (2.1%) patients aged 70 years or older. Overall, 37,135 patients received heart transplants, including 806 (2.2%) who were at least 70.

Compared with younger patients, those 70 and older had a similar risk of death while waiting for a heart (sub-hazard ratio 0.86) and were more likely to receive a heart (SHR 1.36).

There was no significant difference in one-year or five-year survival between younger heart transplant recipients and those who were 70 and older in adjusted analysis that accounted for recipient serum creatinine, recipient BMI, recipient ischemic time, total IMPACT score, PHM ratio, and time on waitlist, the researchers report in the Journal of the American Geriatrics Society.

However, compared with younger heart transplant recipients, elderly recipients received hearts from older donors (30 vs 36 years) and were more likely to receive hearts from donors with diabetes (3.0% vs 5.1%), hypertension (13.8% vs 17.4%), higher IMPACT score (4 vs 6), and higher donor-recipient PHM ratio (1.13 vs 1.16).

“At present in the U.S., there is a shortage of donor organs which is further compounded by less than 50% utilization rate of these available donors as many donor organs are deemed high risk for recipients,” said lead study author Dr. Abhishek Jaiswal of the Hartford HealthCare Heart and Vascular Institute at Hartford Hospital in Connecticut.

Given the scarcity of donor hearts, it’s likely that elderly patients listed for heart transplants who were perceived to have a limited lifespan were offered less optimal organs from higher-risk donors to preserve the donor pool for younger patients awaiting hearts, Dr. Jaiswal said by email.

The study results, however, suggest that this may not be the right way to allocate limited donor hearts, Dr. Jaiswal said.

“Chronological age per se should not be deemed a contraindication for heart transplant,” Dr. Jaiswal said.

For adults 70 and older, the overall mortality incidence was 11.5% at one year post-transplant and 20.4% at five years, compared with 10.4% and 10.2%, respectively for recipients under 70.

One limitation of the study is that it included a relatively small sample of elderly transplant recipients, the authors note. It’s also possible that elderly recipients were healthier than their younger counterparts because they were screened for comorbidities, organ dysfunction, and frailty.

Even so, the results underscore that age alone shouldn’t determine eligibility for a heart transplant, said Dr. Tariq Ahmad, medical director of Heart Transplantation and Mechanical Circulatory Support at the Yale School of Medicine and Yale New Haven Hospital in Connecticut.

“There is little reason to have an age cutoff for transplant and candidacy should be based on individual assessment of patients,” Dr. Ahmad, who wasn’t involved in the study, said by email. “Some of my most successful post-transplant patients have been in the 70s.”

SOURCE: https://bit.ly/3d7Xynx Journal of the American Geriatrics Society, online June 8, 2021.

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