Key result
Heart transplant recipients transplanted at younger ages had lower mortality compared to those aged 17 to 24 years (HR 0.813; 95% CI 0.663-0.997; P=0.047), independent of reported nonadherence.
Why the study?
Does age at transplantation (17-24 years) increase mortality hazard in heart transplant recipients independent of reported nonadherence to immunosuppressive medication?
Cohort (n=3,081)
Yes
Does age at transplantation (17-24 years) increase mortality hazard in heart transplant recipients independent of reported nonadherence to immunosuppressive medication?
The increased mortality hazard observed in young adult heart transplant recipients (ages 17-24) persists even in the absence of reported nonadherence to immunosuppressive medication, suggesting other factors contribute to this high-risk window.
Persistent mortality risk in late adolescence after HTx despite no reported nonadherence cautions against sole focus on adherence; leaves open unidentified age-related factors.
BACKGROUND: Young adult heart transplantation (HTx) recipients experience high mortality risk attributed to increased nonadherence to immunosuppressive medication in this age window. This study sought to test whether a high-risk age window in HTx recipients persisted in the absence of reported nonadherence. METHODS: Heart transplantation recipients aged 2 to 40 years, transplanted between October 1999 and January 2007, were identified in the United Network for Organ Sharing database. Multivariable survival analysis was used to estimate influences of age at transplantation and attained posttransplant age on mortality hazard among patients stratified by center report of nonadherence to immunosuppression that compromised recovery. RESULTS: Three thousand eighty-one HTx recipients were included, with univariate analysis demonstrating peak hazards of mortality and reported nonadherence among 567 patients transplanted between ages 17 and 24 years. Multivariable analysis adjusting for reported nonadherence demonstrated lower mortality among patients transplanted at younger (hazards ratio, 0.813; 95% confidence interval, 0.663-0.997; P = 0.047) or older (hazards ratio, 0.835; 95% confidence interval, 0.701-0.994; P = 0.042) ages. Peak mortality hazard at ages 17 to 24 years was confirmed in the subgroup of patients with no nonadherence reported during follow-up. This result was replicated using attained age after HTx as the time metric, with younger and older ages predicting improved survival in the absence of reported nonadherence. CONCLUSIONS: Late adolescence and young adulthood coincide with greater mortality hazard and greater chances of nonadherence to immunosuppressive medication after HTx, but the elevation of mortality hazard in this age range persists in the absence of reported nonadherence. Other causes of the high-risk age window for post-HTx mortality should be demonstrated to identify opportunities for intervention.
No takes yet. Share an insight, caveat, or question.
Tumin et al. (2016) conducted a cohort in Heart transplantation (n=3,081). Transplantation at younger ages vs. Transplantation at ages 17 to 24 years was evaluated on Mortality (HR 0.813, 95% CI 0.663-0.997, p=0.047). Heart transplant recipients transplanted at younger ages had lower mortality compared to those aged 17 to 24 years (HR 0.813; 95% CI 0.663-0.997; P=0.047), independent of reported nonadherence.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: