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

Objectives: Heart transplantation (HTx) represents the preferred therapy for end-stage heart failure patients. In an aging society, a rising number of older patients suffer 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 166 patients underwent HTx in our department. Mean recipient age at transplantation was 54.47 ± 11.44 years (minimum: 21.71 years, maximum: 72.63 years). Patients were retrospectively divided into three groups according to their age (Group 1: age < 40 years, n = 27; Group 2: age = 40–60 years, n = 78 years; Group 3: age > 60 years, n = 61).

Result: Donor age was comparable between the three groups (Group 1: 40.33 ± 11.15 years; Group 2: 42.21 ± 13.01 years; Group 3: 45.92 ± 12.58 years, p = 0.73). In addition, the groups did not differ regarding recipient high urgency listing status, preoperative mechanical ventricular assistance, cardiac graft function, and allograft ischemia. We did not find significant differences for the incidence of severe primary graft dysfunction necessitating mechanical circulatory support (p = 0.40) as well as common postoperative major morbidity such as hemodialysis (p = 0.13), neurological events (p = 0.71), bleeding complications (p = 0.76), infections (p = 0.53) and early graft rejection (>1R) (p = 0.18). Hospitalization time, stay on intensive care unit and mechanical ventilation time did not differ either. Furthermore, Fisher–Freeman–Halton test revealed no significant differences concerning the 30-day survival (Group 1: 96.3%; Group 2: 88.5%; Group 3: 88.1%, p = 0.58) as well as 1-year survival of the three groups (Group 1: 78.3%; Group 2: 82.3%; Group 3: 68.2%, p = 0.24).

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.

Publication History

Article published online:
19 February 2021