Impact of age over 70 years in the new allocation system on the outcomes of heart transplantation in the US

Area of Science:

• Cardiology
• Transplantation Medicine
• Geriatric Medicine

Background:

• The United Network for Organ Sharing (UNOS) updated heart transplant allocation criteria in 2018.
• The policy change aimed to prioritize sicker patients and accommodate increased ventricular assist device use.
• This study assesses the impact of patient age on outcomes under the new allocation system.

Purpose of the Study:

• To evaluate the effect of patient age (≥70 vs. <70) on mortality after heart transplantation.
• To determine if the 2018 UNOS allocation policy influenced outcomes for older heart transplant recipients.
• To analyze secondary outcomes like stroke, dialysis, pacemaker implantation, and rejection in older patients.

Main Methods:

• Data from the UNOS Registry (2000-2021) for isolated heart transplants in the US.
• Patients were stratified into two age groups: ≥70 years and <70 years.
• Statistical analysis examined mortality and post-transplant complications based on age and allocation policy.

Main Results:

• Patients aged ≥70 were more likely to require dialysis but less likely to experience treated rejection.
• Age ≥70 was a significant predictor of 1-year mortality (adjusted HR: 1.41) but not 5-year mortality.
• The new UNOS allocation policy did not significantly impact mortality for patients aged ≥70.

Conclusions:

• Advanced age (≥70) predicts increased 1-year mortality post-heart transplant.
• Long-term mortality (5 and 10 years) is not significantly affected by age ≥70.
• Current UNOS allocation policies have not demonstrably altered outcomes for heart transplant recipients aged 70 and older.