*Purpose: Simultaneous heart and kidney transplantation (SHKT) is the treatment of choice for patients who suffer both from end-stage heart and kidney disease. However, the impact of recipient’s age on outcomes of SHKT recipients remains unclear.

*Methods: Using the UNOS database STAR files, we analyzed all patients aged ≥ 18 years who received SHKT (n=1114) between Jan 2007 to Mar 2021. A preliminary stepwise cox regression model was created to predict recipient’s 1-year mortality. Age was subsequently added to the model using a 3 degree of freedom smothing spline. A plot of the spline’s adjustment to the hazard across recipient’s age was created with 95% pointwise confidence interval.

*Results: Within 1-year follow up, 120 patients died. Mean age of the recipients was 55.5 ± 11 years (82% male). Forty-six percent of the patients were diabetic and 40% were former smokers. Mean age of the donors was 32 ± 11 years and 19% had female-donor-to-male recipients. A cardiac defibrillator was present in 75% of the patients, while 2% were on ventilator support, 2% on ECMO, 10% had intra-aortic balloon pump, and 45% were on intravenous inotropes. Left ventricular assisted device (LVAD) was present in 4% of the patients at the time of listing, while 4% received LVAD while waiting to get transplant. Spline curves (Figure 1) showed wider confidence intervals for younger (<30 years) and older age (>65years) groups but there was no age threshold associated with higher mortality risk.

*Conclusions: In this national cohort of recipients who underwent SHKT over 10 years, there was no overall threshold impact of age on mortality within one year of transplant. Therefore, in otherwise appropriately selected individuals advanced age alone should not be considered a contraindication to SHKT.

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