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 International Society for Heart and Lung Transplantation amended the guidelines for the upper age limit of heart transplantation (HTx) from 55 years to 70 years and older for carefully selected patients. However, the relation of age to outcomes following of HTx has not been well studied. Objectives: To investigate the impact of recipient age on the occurrence of rejections, vasculopathy, and mortality after HTx. Methods: Study population comprised all consecutive 291 patients who underwent HTx between 1991-2016 and were followed at our center. Patients were categorized by age tertiles: < 46 years (mean 31.4 +/- 11.7, range 16-45, n=90), 46-57 years (mean 51.4 +/- 3.2, range 46-56, n=92), and 57 years (mean 61.6 +/- 3.4, range 57-73, n=109). Results: Patients aged >= 57 years were more often males and had more pre-HTx co-morbidities including hypertension, diabetes, dyslipidemia, and history of smoking (P < 0.05) compared to the younger age groups. Kaplan-Meier analysis by age tertiles showed the rates of major rejections and vasculopathy at 15 years were similar among the three age groups. Mortality rates at 15 years were directly related to the age groups (39%, 52%, 62% log-rank, P = 0.01). However, the association between age and mortality was no longer statistically significant after multivariate analysis (hazard ratio 1.01, 95% confidence interval 1.00-1.03). Conclusions: In a contemporary cohort of patients undergoing HTx, recipient age does not significantly impact the risk of major rejections, vasculopathy, and long-term mortality.