Abstract 16034: Heart Transplant in Older Adults: Outcomes in the Modern Era of Transplant

Introduction: The total number and the proportion of older adults receiving heart transplants have increased over the last two decades. In 2016, the ISHLT guidelines for patients over 70 years of age were updated to remove the use of an alternate-type pool of donors, and now recommend transplanting carefully selected patients over 70 from the general pool.

Aims: This study examines outcomes of older adults (>70) who receive heart transplants in the modern era.

Methods: Adult patients who received heart transplant between January 1, 2010 and December 31, 2021 were identified in the United Network for Organ Sharing (UNOS) registry. Outcomes of interest were mortality at 1 and 5 years after heart transplant.

Results: Those over 70 were more likely to be male, white, have an ischemic etiology of their heart failure, and have had a prior malignancy.

Overall mortality at 1 year was 10.8% for those over 70 and 8.9% for those under 70 (p<0.033). Overall mortality at 5 years was 12.8% for those over 70 and 19.8% for those under 70 (p=0.37).

Time to event survival analysis showed mortality was higher at 1 (HR 1.25, 1.04-1.51, p=0.019) and 5 years (HR 1.21, 1.05-1.39, p=0.006), however if patients conditionally survived the first year, 5-year conditional mortality was not different (HR 1.17, 0.95-1.43, p=0.135).

Those over 70 were less likely to suffer from rejection, more likely to die from infectious disease or malignancy, but less likely to die from cardiovascular causes or graft failure.

Conclusions: Older adults (over 70) who receive heart transplants have slightly worse 1- and 5-year survival but similar conditional 5-year survival to those under 70—the difference is driven by mortality in the first year. Both cohorts’ survival curves are improved compared to transplants in earlier eras. Those over 70 are less likely to experience rejection, consistent with the well-described phenomenon of immunosenescence.