Heart-Kidney Transplantation Appears to Be Acceptable for Patients Greater Than 65 Years of Age

T. Singer-Englar, M. Kittleson, J. Patel, N. Patel, S. Kim, D. Chang, E. Kransdorf, L. Czer, J. A. Kobashigawa

Cedars-Sinai Smidt Heart Institute, Los Angeles, CA

Meeting: 2022 American Transplant Congress

Abstract number: 1123

Keywords: Heart transplant patients

Topic: Clinical Science » Heart » 63 - Heart and VADs: All Topics

Session Information

Session Name: Heart and VADs: All Topics

Session Type: Poster Abstract

Date: Sunday, June 5, 2022

Session Time: 7:00pm-8:00pm

Presentation Time: 7:00pm-8:00pm

Location: Hynes Halls C & D

*Purpose: Heart-kidney transplantation (HKTx) has been found to improve survival in patients with advanced kidney disease who undergo heart transplantation. It is not known whether older patients who undergo HKTx have similar good outcomes. In addition, older patients who undergo HKTx may receive older donor heart and kidney organs. It is not known whether these older donor organs in older recipients also have good outcomes.

*Methods: Between 2010 and 2020, we assessed 145 patients who underwent HKTx and divided the cohort into patients ≥65 years of age and those <65 years of age at time of transplant. We performed a subgroup analysis of the older patients (≥65 years of age) to compare those who received organs from donors ≥40 years of age to those who received organs from donors <40 years of age. Endpoints included 3-year survival, freedom from cardiac allograft vasculopathy (CAV: stenosis ≥30%), and freedom from non-fatal major adverse cardiac events (NF-MACE: myocardial infarction, new congestive heart failure, percutaneous coronary intervention, implantable cardioverter defibrillator/pacemaker implant, stroke), as well as 1-year freedom from acute cellular rejection (ACR) and antibody-mediated rejection (AMR). Baseline and 3-year glomerular filtration rate (GFR) were also evaluated.

*Results: Patients ≥65 years of age had similar outcomes to those <65 years of age in 3-year survival, freedom from CAV, and freedom from NF-MACE. Both groups were similar in 1-year freedom from ACR and AMR and in baseline and 3-year GFR. In the subgroup analysis, older HKTx patients who received an older donor had similar outcomes to older patients who received a younger donor, however 3-year GFR tended to be lower in older patients who received older donors. (See table.)

*Conclusions: Older HKTx patients appear to have acceptable outcomes compared to younger patients. However, when older donors are placed into older recipients, heart outcome is still comparable but GFR may not be as robust.


	HKTx recipient ≥65 years old (n=42)	HKTx recipient <65 years old (n=103)	p-value
3-year survival	85.7%	90.3%	0.495
3-year freedom from CAV	95.2%	96.1%	0.799
3-year freedom from NF-MACE	90.5%	92.2%	0.684
1-year freedom from ACR	92.9%	93.2%	0.896
1-year freedom from AMR	97.6%	92.2%	0.225
Baseline GFR, mL/min/1.73 m²	31.3 ± 15.5	34.9 ± 26.8	0.577
3-year GFR, mL/min/1.73 m²	58.9 ± 15.1	65.9 ± 22.7	0.259

Subgroup analysis of older recipients
	HKTx recipient ≥65 years old, donor <40 years old (n=21)	HKTx recipient ≥65 years old, donor ≥40 years old (n=21)	p-value
3-year survival	81.0%	90.5%	0.293
3-year freedom from CAV	95.2%	95.2%	0.915
3-year freedom from NF-MACE	95.2%	85.7%	0.315
1-year freedom from ACR	95.2%	90.5%	0.565
1-year freedom from AMR	100.0%	95.2%	0.317
Baseline GFR, mL/min/1.73 m²	33.6 ± 16.9	26.7 ± 12.2	0.349
3-year GFR, mL/min/1.73 m²	66.3 ± 11.4	53.1 ± 15.6	0.063

To cite this abstract in AMA style:

Singer-Englar T, Kittleson M, Patel J, Patel N, Kim S, Chang D, Kransdorf E, Czer L, Kobashigawa JA. Heart-Kidney Transplantation Appears to Be Acceptable for Patients Greater Than 65 Years of Age [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/heart-kidney-transplantation-appears-to-be-acceptable-for-patients-greater-than-65-years-of-age/. Accessed November 21, 2024.

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