Risk of recipient age on 1‐year mortality after simultaneous heart–lung transplantation

Abstract

Background Heart‐lung transplantation (HLTx) is relatively uncommon, and there is a paucity of literature to suggest an age at which older recipients may be exposed to excess risk for mortality. This analysis aimed to identify a threshold of age that predicts adverse outcomes after HLTx. Methods The United Network of Organ Sharing registry was used to identify adult patients undergoing HLTx from 2005 to 2021. The primary outcome was 1‐year mortality. Threshold regression was used to identify the threshold at which age impacts 1‐year mortality. Kaplan−Meier analysis was used to model survival, and Cox proportional hazards modeling was used for risk‐adjustment. Results We identified 453 patients undergoing HLTx. Threshold analysis identified that the risk for 1‐year mortality was significantly elevated beyond an age of 58 years, and 47 (10.38%) patients were older than this threshold. On Kaplan−Meier analysis, 1‐year survival was significantly lower in patients > 58 years compared to younger recipients (64.7% vs. 82.0%, p = .007). After risk adjustment, the hazard ratio for 1‐year mortality in recipients older than 58 years was 2.27 (95% confidence interval [1.21−4.28], p = .011). Conclusion A threshold for recipient age of 58 years of age may avoid excess 1‐year mortality after HLTx. However, patients older than this threshold demonstrate acceptable early and midterm survival, and the majority survive to 1 year. Advanced age should be considered in patient selection for HLTx, but may not be a contraindication for candidacy particularly in the absence of other risk factors.

The Impact of T-cell Aging on Alloimmunity and Inflammaging

“…At the same time, higher mortality rates as a consequence of severe infections have been observed in older transplant recipients, 7,10-12 whereas side effects of established immunosuppressants including posttransplant diabetes and calcineurin inhibitor (CNI)–related nephrotoxicity are more frequent in part linked to altered pharmacodynamics. 13,14 Of additional relevance, older transplant recipients have also shown an independently increased risk of chronic allograft loss.…”

“…[6][7][8] A large cohort clinical study in approximately 140 000 kidney transplant recipients listed in the Organ Procurement and Transplantation Network database identified recipient age as the strongest risk factor for rejections during the first year after transplantation with less frequent acute rejections in older transplant recipients. 9 At the same time, higher mortality rates as a consequence of severe infections have been observed in older transplant recipients, 7,[10][11][12] whereas side effects of established immunosuppressants including posttransplant diabetes and calcineurin inhibitor (CNI)-related nephrotoxicity are more frequent in part linked to altered pharmacodynamics. 13,14 Of additional relevance, older transplant recipients have also shown an independently increased risk of chronic allograft loss.…”

Donor and recipient age matching in lung transplantation: A retrospective study

“…Additionally, age can substantially affect the risk of complications in patients undergoing LTx [ 6 , 7 ]. For example, existing studies have demonstrated that older patients receiving LTx exhibit a significant decrease in 1- and 5-year survival compared to patients under 60 years of age [ 8 , 9 ]. Older age serves as a marker for a complex collection of factors, such as comorbidity profiles and underlying diseases, which potentially increase the morbidity and mortality of postoperative patients [ 10 ].…”

Should there be an age limit for advanced therapies?

“…Kwon et al in this journal present their observations on heart‐lung transplant recipients over the age of 58, based on the UNOS database 1 . They find a survival benefit for those younger than 58 year old.…”