Evaluating age-based eligibility thresholds for heart re-transplantation – an analysis of the united network for organ sharing database

Qiudong Chen, Jad Malas, Joshua Chan, Gabriel Esmailian, Dominic Emerson, Dominick Megna, Pedro Catarino, Michael E. Bowdish, Michelle Kittleson, Jignesh Patel, Joanna Chikwe, Jon Kobashigawa, Fardad Esmailian

Research output: Contribution to journalArticlepeer-review


Background: Risk-adjusted survival after late heart re-transplantation may be comparable to primary transplant, but the efficacy of re-transplantation in older candidates is not established. We evaluated outcomes after heart re-transplantation in recipients > 60 years. Methods: We identified 1026 adult patients undergoing isolated heart re-transplantation between 2003 and 2020 from the United Network for Organ Sharing database. Older recipients (> 60 years, n=177) were compared to younger recipients (≤ 60 years, n=849). Five and ten-year post-transplant survival was estimated using the Kalpan-Meier method and adjusted with multivariable Cox models. Results: Older recipients were more likely to be male and have diabetes or previous malignancies with higher baseline creatinine. They also more frequently required pre-transplant ECMO (11.9% vs. 6.8%, p=0.02) and received re-transplantation due to primary graft failure (13.6% vs. 8.5%, p=0.03). After the transplant, older recipients had a higher incidence of stroke (6.8% vs. 2.6%, p=0.01) and dialysis requirements (20.3% vs. 13.2%) before discharge (both p<0.05), and more frequently died from malignancy-related causes (16.3% vs. 3.9%, p<0.001). After adjustment, recipient age >60 was associated with an increased risk of both 5-year (HR 1.42, 95% CI 1.02-2.01, p=0.04) and 10-year mortality (HR 1.72, 95% CI 1.20-2.45, p=0.003). Restricted cubic spline showed a non-linear relationship between recipient age and 10-year mortality. Conclusions: Heart re-transplantation in recipients > 60 years has inferior outcomes compared to younger recipients. Strict patient selection and close follow-up are warranted to ensure the appropriate utilization of donor hearts and to improve long-term outcomes.

Original languageEnglish
Pages (from-to)593-602
Number of pages10
JournalJournal of Heart and Lung Transplantation
Issue number5
StatePublished - May 2023
Externally publishedYes


  • United Network for Organ Sharing Registry
  • heart retransplantation
  • outcomes
  • patient selection
  • recipient age

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