Related Experiment Video
Updated: Jan 8, 2026
Innovative Strategies for Organ Preservation in Heart Transplantation: Uniform Cooling Preservation and Ex-situ Normothermic Perfusion
Published on: November 28, 2025
Comparative Outcomes of Heart Transplant Recipients Aged Below and Above 65 Years: A Single-Center Experience
Nicola Pradegan1, Valentina Lombardi1, Giulia Guerra1
1From the Cardiac Surgery Unit, Cardio-thoraco-vascular and Public Health Department, Padova University Hospital, Padova, Italy.
Insights
Heart transplantation (HT) in patients aged 65 and older shows worse early and late outcomes. Modifiable factors like donor age and perioperative complications significantly impact survival in elderly recipients.
Area of Science:
- Cardiology
- Transplantation Medicine
- Geriatric Medicine
Background:
- Advanced heart failure is increasing in older adults.
- Current guidelines are cautious about heart transplantation (HT) safety in elderly recipients.
- Limited data exists on outcomes for older heart transplant recipients.
Purpose of the Study:
- To evaluate and compare early and late outcomes of heart transplantation (HT) in recipients aged 65 years and older versus those younger than 65.
- To identify factors influencing outcomes in elderly heart transplant recipients.
Main Methods:
- Retrospective analysis of HT recipients from January 2012 to December 2022.
- Comparison of recipients aged ≥65 years (group 1) versus <65 years (group 2).
- Analysis of early outcomes (postoperative complications, in-hospital mortality) and late outcomes (survival rates).
Main Results:
- The elderly group (≥65 years) had a higher burden of cardiovascular risk factors, impaired renal function, and received older donors with more coronary artery disease.
- Group 1 experienced significantly higher rates of postoperative complications and in-hospital mortality (28.8%).
- At a median follow-up of 4.2 years, elderly recipients showed significantly lower survival rates (1-year: 68%, 5-year: 62%).
Conclusions:
- Heart transplantation in patients aged 65 and older is associated with worse early and late outcomes compared to younger recipients.
- Donor age and perioperative complications are significant modifiable factors influencing survival in elderly heart transplant recipients.
- Targeting these modifiable factors may improve clinical results for older heart transplant candidates.
Abstract:
Despite the increasing prevalence of advanced heart failure among older patients, current guidelines remain cautious regarding the safety of heart transplantation (HT) in elderly recipients. This study aimed to evaluate early and late outcomes in older HT recipients. We retrospectively analyzed all patients aged ≥18 years who underwent HT at our center between January 2012 and December 2022, comparing early and late outcomes of recipients ≥65 years (group 1) vs . those <65 (group 2). Groups 1 and 2 comprised 73 (female = 10, median age = 67 years, interquartile range [IQR] = 66-69) and 212 patients (female = 58, median age = 54 years, IQR = 46-60), respectively. Group 1 presented a higher burden of cardiovascular (CV) risk factors and impaired renal function ( p < 0.001); additionally, they more often received older donors ( p < 0.001) with a higher incidence of coronary artery disease ( p = 0.041). Group 1 experienced a significantly higher rate of postoperative complications and in-hospital mortality (n = 21, 28.8%; p < 0.001). At a median follow-up time of 4.2 years (IQR = 1.3-6.9), group 1 showed lower survival rates ( p < 0.001) (1 year = 68%, 95% confidence interval [CI] = 58-80; 5 year = 62%, 95% CI = 51-74). In our experience, HT in patients aged ≥65 years shows worse early and late outcomes; however, among elderly recipients, modifiable factors such as donor age and perioperative complications significantly influence survival and may be targeted to improve clinical results.
Related Concept Videos
01:28Kidney Transplant I: Introduction
01:24Tissue Transplantation
The Biology of Tissue Transplantation
The biology of tissue transplantation hinges on the Major Histocompatibility Complex (MHC) molecules. These molecules...