Key result
Heart transplant at age ≥65 linked to higher in-hospital mortality, reaching ~29%.
Why the study?
Does heart transplantation in patients aged ≥65 years compared to <65 years result in worse early and late outcomes?
Cohort (n=285)
No
Does heart transplantation in patients aged ≥65 years compared to <65 years result in worse early and late outcomes?
p-value: p=<0.001
Heart transplantation in patients aged ≥65 years is associated with higher in-hospital mortality and lower long-term survival compared to younger recipients, supporting current cautious guidelines.
Despite the increasing prevalence of advanced heart failure among older patients, current guidelines remain cautious regarding the safety of heart transplantation (HT) in elderly recipients. This study aimed to evaluate early and late outcomes in older HT recipients. We retrospectively analyzed all patients aged ≥18 years who underwent HT at our center between January 2012 and December 2022, comparing early and late outcomes of recipients ≥65 years (group 1) vs . those <65 (group 2). Groups 1 and 2 comprised 73 (female = 10, median age = 67 years, interquartile range [IQR] = 66-69) and 212 patients (female = 58, median age = 54 years, IQR = 46-60), respectively. Group 1 presented a higher burden of cardiovascular (CV) risk factors and impaired renal function ( p < 0.001); additionally, they more often received older donors ( p < 0.001) with a higher incidence of coronary artery disease ( p = 0.041). Group 1 experienced a significantly higher rate of postoperative complications and in-hospital mortality (n = 21, 28.8%; p < 0.001). At a median follow-up time of 4.2 years (IQR = 1.3-6.9), group 1 showed lower survival rates ( p < 0.001) (1 year = 68%, 95% confidence interval [CI] = 58-80; 5 year = 62%, 95% CI = 51-74). In our experience, HT in patients aged ≥65 years shows worse early and late outcomes; however, among elderly recipients, modifiable factors such as donor age and perioperative complications significantly influence survival and may be targeted to improve clinical results.
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Pradegan et al. (2025) conducted a cohort in Advanced heart failure (n=285). Age ≥65 years vs. Age <65 years was evaluated on In-hospital mortality (p=<0.001). Heart transplant recipients aged ≥65 years experienced significantly higher in-hospital mortality (28.8%) and lower long-term survival rates compared to younger recipients (P<0.001).
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