Do age and functional dependence affect outcomes of simultaneous heart–kidney transplantation?Central MessagePerspective
Iris Feng, BS,
Paul A. Kurlansky, MD,
Yuming Ning, PhD,
Jocelyn Sun, MPH,
Yoshifumi Naka, MD, PhD,
Veli K. Topkara, MD,
Farhana Latif, MD,
Gabriel Sayer, MD,
Nir Y. Uriel, MD,
Koji Takeda, MD, PhD
Affiliations
Iris Feng, BS
Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY
Paul A. Kurlansky, MD
Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY; Department of Surgery, Center of Innovation and Outcomes Research, Columbia University, New York, NY
Yuming Ning, PhD
Department of Surgery, Center of Innovation and Outcomes Research, Columbia University, New York, NY
Jocelyn Sun, MPH
Department of Surgery, Center of Innovation and Outcomes Research, Columbia University, New York, NY
Yoshifumi Naka, MD, PhD
Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY
Veli K. Topkara, MD
Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY
Farhana Latif, MD
Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY
Gabriel Sayer, MD
Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY
Nir Y. Uriel, MD
Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY
Koji Takeda, MD, PhD
Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY; Address for reprints: Koji Takeda, MD, PhD, Division of Cardiac Surgery, Department of Surgery, Columbia University College of Physicians and Surgeons/New York-Presbyterian Hospital, 177 Fort Washington Ave, New York, NY 10032.
Objective: This study assessed characteristics and outcomes of younger (18-65) versus older (>65) recipients of simultaneous heart–kidney (SHK) transplantation with varying functional dependence. Methods: This study retrospectively analyzed 1398 patients from the United Network for Organ Sharing database who received SHK between 2010 and 2021. Patients who were 65 years (n = 236), baseline characteristics were similar and well-balanced between the 2 cohorts. Between matched cohorts, older recipients did not have increased posttransplant mortality compared with younger recipients (90-day survival, P = .85; 7-year survival, P = .61). Multivariable Cox regression analysis found that age (hazard ratio [HR], 1.039 [0.975-1.106], P = .2415) and pretransplant functional status with interaction term for age (some assistance, HR, 0.965 [0.902-1.033], P = .3079; total assistance, HR, 0.976 [0.914-1.041], P = .4610) were not significant risk factors for 7-year post-SHK transplantation mortality. Conclusions: Older and more functionally dependent recipients in this study did not have increased post-SHK transplantation mortality. These findings have important implications for organ allocation among elderly patients, as they support the need for thorough assessment of SHK candidates in terms of comorbidities, rather than exclusion solely based on age and functional dependence.
