High Risk of Graft Failure in Emerging Adult Heart Transplant Recipients

Abstract

Emerging adulthood (17-24 years) is a period of high risk for graft failure in kidney transplant. Whether a similar association exists in heart transplant recipients is unknown. We sought to estimate the relative hazards of graft failure at different current ages, compared with patients between 20 and 24 years old. We evaluated 11 473 patients recorded in the Scientific Registry of Transplant Recipients who received a first transplant at <40 years old and had at least 6 months of graft function. Timedependent Cox models were used to estimate the association between current age (time-dependent) and failure risk, adjusted for time since transplant and other potential confounders. Failure was defined as death following graft failure or retransplant; observation was censored at death with graft function. There were 2567 failures. Crude age-specific graft failure rates were highest in 21-24 year olds (4.2 per 100 person-years). Compared to individuals with the same time since transplant, 21-24 year olds had significantly higher failure rates than all other age periods except 17-20 years (HR 0.92 [95%CI 0.77, 1.09]) and 25-29 years (0.86 [0.73, 1.03]). Among young first heart transplant recipients, graft failure risks are highest in the period from 17 to 29 years of age.Abbreviations: HLA, human leukocyte antigen; HR, hazard ratio; IQR, interquartile range; SES, socioeconomic status; SRTR, Scientific Registry of Transplant Recipients

Feelings of indebtedness and guilt toward donor and immunosuppressive medication adherence among heart transplant (HTx) patients, as assessed in a cross‐sectional study with the Basel Assessment of Adherence to Immunosuppressive Medications Scale (BAASIS)

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Age‐specific risk of renal graft loss from late acute rejection or non‐compliance in the adolescent and young adult period

“…Although the high‐risk window has been identified in other solid organ transplant recipients, the effect is not seen in all organs. Adolescent and young adult heart transplant recipients have an increased rate of graft failure during the ages 17–24 years, however liver transplant recipients do not . Patients with cystic fibrosis who receive a lung transplant have a higher risk of death during this period …”

Outcomes of adolescent recipients after lung transplantation: An analysis of the International Society for Heart and Lung Transplantation Registry

“…The impact of adolescence and its transitions are supported by evidence from Foster et al who showed that the incidence of graft failure in renal, heart and liver transplant recipients peaks between 17 and 21 years of age, regardless of age of transplant. [4][5][6]18 This may be the basis of the poorest outcomes noted in the 15-19-year cohort. Unlike those transplanted in childhood (o10 years), who will have a prolonged period of sustained stability before entering the "high-risk" period, 15-19-year-old recipients enter this "high-risk" period at the time of transplant.…”

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