Does recipient age impact functional outcomes of orthotopic heart transplantation?
BACKGROUND: This study evaluated changes in physical functional performance after orthotopic heart transplantation (OHT) with particular attention to the impact of recipient age on functional outcomes. METHODS: Retrospective review of all first-time, single-organ adult OHTs in the United States between 2005 and 2010. Patients were primarily stratified by age. The validated Karnofsky performance scale, which ranges from 0 (death) to 100 (fully independent with no evidence of disease and no complaints), was used to measure functional status. RESULTS: A total of 10,049 OHT recipients were identified, with 1,431 (14%) aged 65 years or greater. Mean Karnofsky score prior to OHT was comparable between cohorts (younger: 50.7±25.2 versus older: 50.1±25.0; p=0.38). At a median follow-up of 2.1 years (interquartile range 0.7 to 3.3 years), 64% of OHT recipients had improved functional performance. The mean improvement in Karnofsky score was similar between younger and older patients (19.6±42.0 vs 17.5±41.8; p=0.10). Twenty percent of younger patients were functionally independent prior to OHT, with 67% being functionally independent at last follow-up (p<0.001). Similarly, in the older cohort, 20% were functionally independent prior to OHT, with 66% being functionally independent at last follow-up (p<0.001). Multivariable analysis adjusting for potential confounders confirmed that age, both as a continuous and categoric variable, did not impact odds of functional improvement after OHT. Subanalysis using 70 years as the age cutoff produced similar results. CONCLUSIONS: In the modern era, OHT is associated with improvements in functional performance in most recipients, and this beneficial effect is preserved across the age spectrum. These data provide a benchmark for functional outcomes after OHT and may have important implications in organ allocation.
Duke Scholars
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- United States
- Treatment Outcome
- Transplantation, Homologous
- Tissue and Organ Procurement
- Survival Analysis
- Risk Assessment
- Retrospective Studies
- Respiratory System
- Quality Improvement
- Postoperative Complications
Citation
Published In
DOI
EISSN
Publication Date
Volume
Issue
Start / End Page
Location
Related Subject Headings
- United States
- Treatment Outcome
- Transplantation, Homologous
- Tissue and Organ Procurement
- Survival Analysis
- Risk Assessment
- Retrospective Studies
- Respiratory System
- Quality Improvement
- Postoperative Complications