Outcomes of Combined Heart-Kidney Transplantation in Older Recipients
Copyright © 2023 Curry Sherard et al..
Objectives: The upper limit of recipient age for combined heart-kidney transplantation (HKT) remains controversial. This study evaluated the outcomes of HKT in patients aged ≥65 years.
Methods: The United Network of Organ Sharing (UNOS) was used to identify patients undergoing HKT from 2005 to 2021. Patients were stratified by age at transplantation: <65 and ≥ 65 years. The primary outcome was one-year mortality. Secondary outcomes included 90-day and 5-year mortality, postoperative new-onset dialysis, postoperative stroke, acute rejection prior to discharge, and rejection within one-year of HKT. Survival was compared using Kaplan-Meier analysis, and risk adjustment for mortality was performed using Cox proportional hazards modeling.
Results: HKT in recipients aged ≥65 significantly increased from 5.6% of all recipients in 2005 to 23.7% in 2021 (p=0.002). Of 2,022 HKT patients in the study period, 372 (18.40%) were aged ≥65. Older recipients were more likely to be male and white, and fewer required dialysis prior to HKT. There were no differences between cohorts in unadjusted 90-day, 1-year, or 5-year survival in Kaplan-Meier analysis. These findings persisted after risk-adjustment, with an adjusted hazard for one-year mortality for age ≥65 of 0.91 (95% CI (0.63-1.29), p=0.572). As a continuous variable, increasing age was not associated with one-year mortality (HR 1.01 (95% CI (1.00-1.02), p=0.236) per year). Patients aged ≥65 more frequently required new-onset dialysis prior to discharge (11.56% vs. 7.82%, p=0.051). Stroke and rejection rates were comparable.
Conclusion: Combined HKT is increasing in older recipients, and advanced age ≥65 should not preclude HKT.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:2023 |
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| Enthalten in: |
Cardiology research and practice - 2023(2023) vom: 30., Seite 4528828 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Sherard, Curry [VerfasserIn] |
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| Anmerkungen: |
Date Revised 04.07.2023 published: Electronic-eCollection Citation Status PubMed-not-MEDLINE |
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| doi: |
10.1155/2023/4528828 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| 500 | |a published: Electronic-eCollection | ||
| 500 | |a Citation Status PubMed-not-MEDLINE | ||
| 520 | |a Copyright © 2023 Curry Sherard et al. | ||
| 520 | |a Objectives: The upper limit of recipient age for combined heart-kidney transplantation (HKT) remains controversial. This study evaluated the outcomes of HKT in patients aged ≥65 years | ||
| 520 | |a Methods: The United Network of Organ Sharing (UNOS) was used to identify patients undergoing HKT from 2005 to 2021. Patients were stratified by age at transplantation: <65 and ≥ 65 years. The primary outcome was one-year mortality. Secondary outcomes included 90-day and 5-year mortality, postoperative new-onset dialysis, postoperative stroke, acute rejection prior to discharge, and rejection within one-year of HKT. Survival was compared using Kaplan-Meier analysis, and risk adjustment for mortality was performed using Cox proportional hazards modeling | ||
| 520 | |a Results: HKT in recipients aged ≥65 significantly increased from 5.6% of all recipients in 2005 to 23.7% in 2021 (p=0.002). Of 2,022 HKT patients in the study period, 372 (18.40%) were aged ≥65. Older recipients were more likely to be male and white, and fewer required dialysis prior to HKT. There were no differences between cohorts in unadjusted 90-day, 1-year, or 5-year survival in Kaplan-Meier analysis. These findings persisted after risk-adjustment, with an adjusted hazard for one-year mortality for age ≥65 of 0.91 (95% CI (0.63-1.29), p=0.572). As a continuous variable, increasing age was not associated with one-year mortality (HR 1.01 (95% CI (1.00-1.02), p=0.236) per year). Patients aged ≥65 more frequently required new-onset dialysis prior to discharge (11.56% vs. 7.82%, p=0.051). Stroke and rejection rates were comparable | ||
| 520 | |a Conclusion: Combined HKT is increasing in older recipients, and advanced age ≥65 should not preclude HKT | ||
| 650 | 4 | |a Journal Article | |
| 700 | 1 | |a Sama, Vineeth |e verfasserin |4 aut | |
| 700 | 1 | |a Kwon, Jennie H |e verfasserin |4 aut | |
| 700 | 1 | |a Shorbaji, Khaled |e verfasserin |4 aut | |
| 700 | 1 | |a Huckaby, Lauren V |e verfasserin |4 aut | |
| 700 | 1 | |a Welch, Brett A |e verfasserin |4 aut | |
| 700 | 1 | |a Inampudi, Chakradhari |e verfasserin |4 aut | |
| 700 | 1 | |a Tedford, Ryan J |e verfasserin |4 aut | |
| 700 | 1 | |a Kilic, Arman |e verfasserin |4 aut | |
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