Prognostic Value of Ambulatory Status at Transplant in Older Heart Transplant Recipients: Implications for Organ Allocation Policy
- Author:
Junho HYUN
1
;
Jong-Chan YOUN
;
Jung Ae HONG
;
Darae KIM
;
Jae-Joong KIM
;
Myoung Soo KIM
;
Jaewon OH
;
Jin-Jin KIM
;
Mi-Hyang JUNG
;
In-Cheol KIM
;
Sang-Eun LEE
;
Jin Joo PARK
;
Min-Seok KIM
;
Sung-Ho JUNG
;
Hyun-Jai CHO
;
Hae-Young LEE
;
Seok-Min KANG
;
Dong-Ju CHOI
;
Jon A. KOBASHIGAWA
;
Josef STEHLIK
;
Jin-Oh CHOI
Author Information
- Publication Type:Original Article
- From:Journal of Korean Medical Science 2025;40(3):e14-
- CountryRepublic of Korea
- Language:English
-
Abstract:
Background:Shortage of organ donors in the Republic of Korea has become a major problem. To address this, it has been questioned whether heart transplant (HTx) allocation should be modified to reduce priority of older patients. We aimed to evaluate post-HTx outcomes according to recipient age and specific pre-HTx conditions using a nationwide prospective cohort.
Methods:We analyzed clinical characteristics of 628 patients from the Korean Organ Transplant Registry who received HTx from January 2015 to December 2020. Enrolled recipients were divided into three groups according to age. We also included comorbidities including ambulatory status. Non-ambulatory status was defined as pre-HTx support with either extracorporeal membrane oxygenation, continuous renal replacement therapy, or mechanical ventilation.
Results:Of the 628 patients, 195 were < 50 years, 322 were 50–64 years and 111 were ≥ 65years at transplant. Four hundred nine (65.1%) were ambulatory and 219 (34.9%) were nonambulatory. Older recipients tended to have more comorbidities, ischemic cardiomyopathy, and received older donors. Post-HTx survival was significantly lower in older recipients (P = 0.025) and recipients with non-ambulatory status (P < 0.001). However, in contrast to non-ambulatory recipients who showed significant survival differences according to the recipient’s age (P = 0.004), ambulatory recipients showed comparable outcomes (P = 0.465).
Conclusion:Our results do not support use of age alone as an allocation criterion. Transplant candidate age in combination with some comorbidities such as non-ambulatory status may identify patients at a sufficiently elevated risk at which suitability of HTx should be reconsidered.
