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In many heart transplant (HTx) programs, patients greater than 65 years of age who have had a previous left ventricular assist device (LVAD) are not candidates for HTX. They are kept at destination therapy. It is believed that these patients will have complications if transplanted. It has not been well established as to the outcome of these older LVAD patients undergoing HTx. Between 2010 and 2021, we assessed 35 patients who underwent a previous LVAD placement and subsequently underwent HTx at ≥65 years of age (range 65 to 70). A control group was comprised of patients (≥65 years) who underwent HTx without LVAD support. Post-transplant outcomes included 30-day and 1-year survival as well as 1-year freedom from non-fatal major adverse cardiac events (NF-MACE: myocardial infarction, new congestive heart failure, percutaneous coronary intervention, implantable cardioverter defibrillator/pacemaker implant, stroke), cardiac allograft vasculopathy (CAV: stenosis ≥30%), acute cellular rejection (ACR), and antibody-mediated rejection (AMR). LVAD patients who underwent HTx at the age ≥65 years appear to have comparable outcomes compared to patients who underwent HTx without LVAD support ≥65 years. 1-year survival, freedom from NF-MACE, CAV, ACR, AMR were not significantly different. Older patients (≥65years) supported on an LVAD do not have compromised post-HTx outomes. These patients do not necessarily need to be committed to destination therapy. [ABSTRACT FROM AUTHOR]

Heart-kidney transplant (HKTx) is limited by donor availability, and research has suggested that older recipients have less favorable outcomes. However, it is not well established if older recipients of HKTx versus heart transplant alone (HATx) have acceptable post-transplant outcomes. Therefore, we sought to answer this question in our large single center program. Between 2010 and 2018, we assessed 50 HKTx patients 60 years of age and older. We compared these to older patients undergoing HATx in a contemporaneous era. Endpoints included 5-year survival, freedom from cardiac allograft vasculopathy (CAV, as defined by stenosis ≥30%), freedom from non-fatal major adverse cardiac events (NF-MACE: myocardial infarction, new congestive heart failure, percutaneous coronary intervention, implantable cardioverter defibrillator/pacemaker implant, stroke) and 1-year freedom from rejection [any treated rejection (ATR), acute cellular rejection (ACR), antibody-mediated rejection (AMR)]. Development of delayed graft function, defined as the need for temporary hemodialysis within the first 2 weeks after transplant, was evaluated for the HKTx group. Older patients who underwent HKTx compared to older patients who underwent heart HATx had similar 5-year survival and freedom from CAV and NF-MACE and 1-year freedom from rejection (see table). The older heart-kidney group had 19/50 patients (38%) develop delayed graft function with all but 1 patient recovering renal function. Older HKTx recipients have acceptable outcomes compared to older recipients of HATx. Older age (>60yo) should not be a contraindication to HKTx. [ABSTRACT FROM AUTHOR]