• J. Korean Med. Sci. · Jan 2025

    Prognostic Value of Ambulatory Status at Transplant in Older Heart Transplant Recipients: Implications for Organ Allocation Policy.

    • Junho Hyun, 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, and Jin-Oh Choi.
    • Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
    • J. Korean Med. Sci. 2025 Jan 20; 40 (3): e14e14.

    BackgroundShortage 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.MethodsWe 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.ResultsOf the 628 patients, 195 were < 50 years, 322 were 50-64 years and 111 were ≥ 65 years at transplant. Four hundred nine (65.1%) were ambulatory and 219 (34.9%) were non-ambulatory. 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).ConclusionOur 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.© 2025 The Korean Academy of Medical Sciences.

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