Impact of Recipient Age on Differential Causes of Heart Transplant Mortality. Is It Time To Personalize Post-Transplant Management?

Abstract

Purpose Survival beyond one year after heart transplantation has remained without improvement for the last two decades. A more individualized approach to post-transplant care could result in reduction of long-term mortality. While recipient age has been associated with an increased incidence of certain post-transplant morbidities, its impact on causes-specific mortality has not been well described. Methods and Materials We examined ISHLT Registry data of patients transplanted between 1995 and 2011. We evaluated post-transplant survival and leading causes of death in 6 groups, selected based on recipient age: 18-29, 30-39, 40-49, 50-59, 60-69 and >70 years. Results The study included 52,995 patients. Ten-year survival was lower in heart transplant recipients in the two more advanced age groups – 49% for 60-69 years and 36% for >70 years, p Figure , panel A-B) and cardiac allograft vasculopathy was highest in younger recipients, while the cumulative incidence of deaths related to infection, malignancy ( Figure , panel C-D) and renal failure was highest in older recipients. Conclusions this large cohort of heart transplant recipients, specific causes of death varied significantly with recipient age. Our data suggest that more personalized strategies, possibly including different immunosuppression strategies based on recipient age, might result in improved post-transplant survival. This hypothesis should be tested prospectively.