Heart Transplantation in an Aging Society: Impact of Recipient Age on Postoperative Outcome

Abstract

Purpose Heart transplantation (HTx) represents the preferred therapy for end-stage heart failure patients. In an aging society, a rising number of older patients suffers from heart failure today. Simultaneously, the number of performed HTx is limited by the lack of suitable donor organs. Therefore, the questions arise whether older patients should be transplanted or not. In contrast to donor age, which definitely impacts the outcome after HTx, the impact of recipient age is less well analyzed. Methods Between 2010 and mid 2020 a total of 178 patients underwent HTx in our department. Mean recipient age at transplantation was 54.18±11.61 years (minimum 21.71 years, maximum 72.63 years). Patients were retrospectively divided into three groups according to their age (Group 1: age 60 years, n=65. Results Donor age significantly differed between the three groups (Group 1: 40.63±10.74 years; Group 2: 41.40±13.61 years; Group 3: 46.57±12.54 years, p=0.02). In addition, patients of group 1 were significantly more often listed high urgency listing status (p=0.03). However, preoperative mechanical ventricular assistance, cardiac graft function and allograft ischemia were comparable between all groups. We did not find significant differences for the incidence of severe primary graft dysfunction necessitating mechanical circulatory support (p=0.44) as well as common postoperative major morbidity such as haemodialysis (p=0.10), neurological events (p=0.60), bleeding complications (p=0.79), infections (p=0.40) and early graft rejection (>1R) (p=0.32). Postoperative hospitalization and mechanical ventilation times did not differ either. Furthermore, Fisher-Freeman-Halton test revealed no significant differences concerning the 30-day survival (Group 1: 96.6%; Group 2: 87.5%; Group 3: 87.7%, p=0.44) as well as one-year survival of the three groups (Group 1: 79.2%; Group 2: 82.1%; Group 3: 69.8%, p=0.29). Conclusion In our single-center analysis recipient age did not significantly impact the outcome after HTx. Both postoperative morbidity and mortality were comparable for patients of different age groups. We did not observe any significant disadvantages for recipients older than 60 years compared with their younger counterparts. Thus, after careful and individual selection we support HTx in elderly patients.