Graft failure risk has been shown to peak during emerging adulthood (18-25 y) among kidney transplant recipients. The association between age and graft failure risk in heart transplant recipients is unknown; important differences may exist between organ types. We sought to estimate age-specific graft failure rates in young heart transplant recipients who had at least 6 months of graft function, and to estimate the relative hazards of graft failure at different ages, compared with at 21-24 years of age. We evaluated 11,473 patients recorded in the Scientific Registry of Transplant Recipients (SRTR) database who received a first heart transplant at <40 years old (1988-2012) and had at least 6 months of graft function; 6926 (60%) were <25 years at transplant. Time-dependent Cox models with time-varying covariates were used to estimate the association between age (time-dependent) and the risk of graft failure (defined as death after graft failure or re-transplant). Models included sex, race, era, socioeconomic status, insurer, comorbidity, and primary diagnosis. There were 2567 graft failures over a median follow-up of 5.9 years (IQR 2.7 – 10.6) years. Crude age-specific graft failure rates were highest in 21-24 year-olds (4.2 per 100 person-years). Compared to 21-24 year-olds with the same time since transplant, graft failure rates were significantly lower in 2-16 year-olds and in those ≥30 years old; failure rates were not significantly different in 17-20 year olds or 25-29 year-olds (HR 0.92 [95% CI 0.77, 1.09] for 17-20 year-olds and 0.86 [0.73, 1.03] for 25-29 year-olds). Among first heart transplant recipients <40 years old, older adolescents and young adults (17-29 years old) have the highest risk of graft failure, irrespective of age at transplant.

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