High Risk of Graft Failure in Emerging Adult Heart Transplant Recipients

Area of Science:

• Cardiology
• Transplantation Medicine
• Immunology

Background:

• Emerging adulthood (17-24 years) is a high-risk period for kidney graft failure.
• The association between age during emerging adulthood and heart transplant graft failure is not well-established.
• Understanding age-related risks is crucial for optimizing post-transplant care in young heart recipients.

Purpose of the Study:

• To estimate the relative hazards of graft failure in heart transplant recipients across different current ages.
• To compare graft failure risks in young adults to a reference age group (20-24 years).
• To identify specific age periods within young adulthood associated with increased heart transplant graft failure.

Main Methods:

• Analysis of 11,473 first heart transplant recipients (<40 years old) from the Scientific Registry of Transplant Recipients (1988-2013).
• Inclusion criteria: at least 6 months of graft function post-transplant.
• Time-dependent Cox models used to assess the association between current age and graft failure risk, adjusted for time since transplant and confounders.

Main Results:

• Graft failure was defined as death or retransplant; 2567 failures were recorded.
• Crude graft failure rates peaked in the 21-24 year age group (4.2 per 100 person-years).
• Compared to the 20-24 year olds, recipients aged 17-29 years showed the highest graft failure risks, with statistically significant elevated risks observed in the 25-29 year group (HR 0.86 [0.73, 1.03]) and similar trends in the 17-20 year group (HR 0.92 [0.77, 1.09]).

Conclusions:

• The highest risks for graft failure among young first heart transplant recipients occur between 17 and 29 years of age.
• This 'emerging adulthood' period represents a critical window for intensified monitoring and support in heart transplant recipients.
• Further research into the specific factors contributing to graft failure in this age group is warranted.