Impact of age over 70 years in the new allocation system on the outcomes of heart transplantation in the US
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2024
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| author | Marco Gemelli Ilias P. Doulamis Mariangela Addonizio Aspasia Tzani Athanasios Rempakos Polydoros Kampaktsis Alvise Guariento Ernesto Ruiz Dunque Rabea Asleh Paulino Alvarez Alexandros Briasoulis |
| author_facet | Marco Gemelli Ilias P. Doulamis Mariangela Addonizio Aspasia Tzani Athanasios Rempakos Polydoros Kampaktsis Alvise Guariento Ernesto Ruiz Dunque Rabea Asleh Paulino Alvarez Alexandros Briasoulis Marco Gemelli Ilias P. Doulamis Mariangela Addonizio Aspasia Tzani Athanasios Rempakos Polydoros Kampaktsis Alvise Guariento Ernesto Ruiz Dunque Rabea Asleh Paulino Alvarez Alexandros Briasoulis |
| collection | Wiley Open Access |
| contents | Impact of age over 70 years in the new allocation system on the outcomes of heart transplantation in the US Marco Gemelli Ilias P. Doulamis Mariangela Addonizio Aspasia Tzani Athanasios Rempakos Polydoros Kampaktsis Alvise Guariento Ernesto Ruiz Dunque Rabea Asleh Paulino Alvarez Alexandros Briasoulis Clinical Transplantation AbstractBackgroundUnited Network for Organ Sharing (UNOS) allocation criteria changed in 2018 to accommodate the increased prevalence of patients on a ventricular assist device as a bridge to heart transplant and prioritize sicker people in anticipation of a heart graft. We aimed to assess the impact of patient age in the new allocation policy on mortality following heart transplantation. Secondary outcomes included the effect of age ≥70 on post‐transplant events, including stroke, dialysis, pacemaker, and rejection requiring treatment.MethodsThe UNOS Registry was queried to identify patients who underwent heart transplants alone in the US between 2000 and 2021. Patients were divided into groups according to their age (over 70 and under 70 years old).ResultsPatients aged over 70 were more likely to require dialysis during follow‐up, but less likely to experience rejection requiring treatment, compared with patients aged <70. Age ≥70 in the new allocation system was a significant predictor of 1‐year mortality (adjusted HR: 1.41; 95% CI: 1.05–1.91; p = .024), but its effect on 5‐year mortality was not significant after adjusting for potential confounders (adjusted HR: 1.27; 95% CI:.97–1.66; p = .077). Undergoing transplantation under the new allocation policy vs the old allocation policy was not a significant predictor of mortality in patients over 70 years old.ConclusionsAge ≥70 is a significant predictor of 1‐year mortality following heart transplantation, but not at 5 and 10 years; however, the new allocation does not seem to have changed the outcomes for this group of patients. 10.1111/ctr.15317 http://onlinelibrary.wiley.com/termsAndConditions#vor |
| doi_str_mv | 10.1111/ctr.15317 |
| format | Artículo Open Access |
| id | wiley_oa_10_1111_ctr_15317 |
| institution | Wiley Open Access |
| license_str_mv | http://onlinelibrary.wiley.com/termsAndConditions#vor |
| publishDate | 2024 |
| publisher | Wiley |
| record_format | wiley_oa |
| spellingShingle | Impact of age over 70 years in the new allocation system on the outcomes of heart transplantation in the US Marco Gemelli Ilias P. Doulamis Mariangela Addonizio Aspasia Tzani Athanasios Rempakos Polydoros Kampaktsis Alvise Guariento Ernesto Ruiz Dunque Rabea Asleh Paulino Alvarez Alexandros Briasoulis Clinical Transplantation Impact of age over 70 years in the new allocation system on the outcomes of heart transplantation in the US Marco Gemelli Ilias P. Doulamis Mariangela Addonizio Aspasia Tzani Athanasios Rempakos Polydoros Kampaktsis Alvise Guariento Ernesto Ruiz Dunque Rabea Asleh Paulino Alvarez Alexandros Briasoulis Clinical Transplantation AbstractBackgroundUnited Network for Organ Sharing (UNOS) allocation criteria changed in 2018 to accommodate the increased prevalence of patients on a ventricular assist device as a bridge to heart transplant and prioritize sicker people in anticipation of a heart graft. We aimed to assess the impact of patient age in the new allocation policy on mortality following heart transplantation. Secondary outcomes included the effect of age ≥70 on post‐transplant events, including stroke, dialysis, pacemaker, and rejection requiring treatment.MethodsThe UNOS Registry was queried to identify patients who underwent heart transplants alone in the US between 2000 and 2021. Patients were divided into groups according to their age (over 70 and under 70 years old).ResultsPatients aged over 70 were more likely to require dialysis during follow‐up, but less likely to experience rejection requiring treatment, compared with patients aged <70. Age ≥70 in the new allocation system was a significant predictor of 1‐year mortality (adjusted HR: 1.41; 95% CI: 1.05–1.91; p = .024), but its effect on 5‐year mortality was not significant after adjusting for potential confounders (adjusted HR: 1.27; 95% CI:.97–1.66; p = .077). Undergoing transplantation under the new allocation policy vs the old allocation policy was not a significant predictor of mortality in patients over 70 years old.ConclusionsAge ≥70 is a significant predictor of 1‐year mortality following heart transplantation, but not at 5 and 10 years; however, the new allocation does not seem to have changed the outcomes for this group of patients. 10.1111/ctr.15317 http://onlinelibrary.wiley.com/termsAndConditions#vor |
| title | Impact of age over 70 years in the new allocation system on the outcomes of heart transplantation in the US |
| topic | Clinical Transplantation |
| url | https://onlinelibrary.wiley.com/doi/10.1111/ctr.15317 |