Sollie Zachary W, Kwon Jennie H, Usry Benjamin, Shorbaji Khaled, Welch Brett A, Hashmi Zubair A, Witer Lucas, Pope Nicolas, Tedford Ryan J, Kilic Arman
Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC.
Division of Cardiothoracic Surgery, Department of Surgery, Virginia Commonwealth University, Richmond, Va.
J Thorac Cardiovasc Surg. 2025 Jan;169(1):134-145.e1. doi: 10.1016/j.jtcvs.2024.03.015. Epub 2024 Mar 20.
Studies demonstrate that heart transplantation can be performed safely in septuagenarians. We evaluate the outcomes of septuagenarians undergoing heart transplantation after the US heart allocation change in 2018.
The United Network for Organ Sharing registry was used to identify heart transplant recipients aged 70 years or more between 2010 and 2021. Primary outcomes were 90-day and 1-year mortality. Kaplan-Meier, multivariable Cox proportional hazards, and accelerated failure time models were used for unadjusted and risk-adjusted analyses.
A total of 27,403 patients underwent heart transplantation, with 1059 (3.9%) aged 70 years or more. Patients aged 70 years or more increased from 3.7% before 2018 to 4.5% after 2018 (P = .003). Patients aged 70 years or more before 2018 had comparable 90-day and 1-year survivals relative to patients aged less than 70 years (90 days: 93.8% vs 94.2%, log-rank P = .650; 1 year: 89.4% vs 91.1%, log-rank P = .130). After 2018, septuagenarians had lower 90-day and 1-year survivals (90 days: 91.4% vs 95.0%, log-rank P = .021; 1 year: 86.5% vs 90.9%, log-rank P = .018). Risk-adjusted analysis showed comparable 90-day mortality (hazard ratio, 1.29; 0.94-1.76, P = .110) but worse 1-year mortality (hazard ratio, 1.32; 1.03-1.68, P = .028) before policy change. After policy change, both 90-day and 1-year mortalities were higher (90 days: HR, 1.99; 1.23-3.22, P = .005; 1 year: hazard ratio, 1.71; 1.14-2.56, P = .010). An accelerated failure time model showed comparable 90-day (0.42; 0.16-1.44; P = .088) and 1-year (0.48; 0.18-1.26; P = .133) survival postallocation change.
Septuagenarians comprise a greater proportion of heart transplant recipients after the allocation change, and their post-transplant outcomes relative to younger recipients have worsened.
研究表明，七十多岁的老人可以安全地接受心脏移植手术。我们评估了2018年美国心脏分配政策改变后七十多岁老人接受心脏移植的结果。
利用器官共享联合网络登记处的数据，确定2010年至2021年间年龄在70岁及以上的心脏移植受者。主要结局指标为90天和1年死亡率。采用Kaplan-Meier法、多变量Cox比例风险模型和加速失效时间模型进行未调整分析和风险调整分析。
共有27403例患者接受了心脏移植，其中1059例（3.9%）年龄在70岁及以上。70岁及以上患者的比例从2018年前的3.7%升至2018年后的4.5%（P = 0.003）。2018年前70岁及以上患者的90天和1年生存率与70岁以下患者相当（90天：93.8%对94.2%，对数秩检验P = 0.650；1年：89.4%对91.1%，对数秩检验P = 0.130）。2018年后，七十多岁老人的90天和1年生存率较低（90天：91.4%对95.0%，对数秩检验P = 0.021；1年：86.5%对90.9%，对数秩检验P = 0.018）。风险调整分析显示，政策改变前90天死亡率相当（风险比，1.29；0.94 - 1.76，P = 0.110），但1年死亡率更差（风险比，1.32；1.03 - 1.68，P = 0.028）。政策改变后，90天和1年死亡率均更高（90天：风险比，1.99；1.23 - 3.22，P = 0.005；1年：风险比，1.71；1.14 - 2.56，P = 0.010）。加速失效时间模型显示分配政策改变后90天（0.42；0.16 - 1.44；P = 0.088）和1年（0.
