Objectives. The upper limit of recipient age for combined heart-kidney transplantation (HKT) remains controversial. This study evaluated the outcomes of HKT in patients aged ≥65 years. Methods. The United Network of Organ Sharing (UNOS) was used to identify patients undergoing HKT from 2005 to 2021. Patients were stratified by age at transplantation: <65 and ≥ 65 years. The primary outcome was one-year mortality. Secondary outcomes included 90-day and 5-year mortality, postoperative new-onset dialysis, postoperative stroke, acute rejection prior to discharge, and rejection within one-year of HKT. Survival was compared using Kaplan–Meier analysis, and risk adjustment for mortality was performed using Cox proportional hazards modeling. Results. HKT in recipients aged ≥65 significantly increased from 5.6% of all recipients in 2005 to 23.7% in 2021 (). Of 2,022 HKT patients in the study period, 372 (18.40%) were aged ≥65. Older recipients were more likely to be male and white, and fewer required dialysis prior to HKT. There were no differences between cohorts in unadjusted 90-day, 1-year, or 5-year survival in Kaplan–Meier analysis. These findings persisted after risk-adjustment, with an adjusted hazard for one-year mortality for age ≥65 of 0.91 (95% CI (0.63–1.29), ). As a continuous variable, increasing age was not associated with one-year mortality (HR 1.01 (95% CI (1.00–1.02), ) per year). Patients aged ≥65 more frequently required new-onset dialysis prior to discharge (11.56% vs. 7.82%, ). Stroke and rejection rates were comparable. Conclusion. Combined HKT is increasing in older recipients, and advanced age ≥65 should not preclude HKT.

中文翻译：

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老年受者心肾联合移植的结果

目标。心肾联合移植（HKT）的受者年龄上限仍存在争议。本研究评估了 65 岁以上患者的 HKT 结局。方法。联合器官共享网络 (UNOS) 用于识别 2005 年至 2021 年接受 HKT 的患者。患者按移植时年龄进行分层：<65 岁和≥ 65 岁。主要结局是一年死亡率。次要结局包括 90 天和 5 年死亡率、术后新发透析、术后卒中、出院前急性排斥反应以及 HKT 一年内排斥反应。使用 Kaplan-Meier 分析比较生存率，并使用 Cox 比例风险模型进行死亡率风险调整。结果。年龄≥65 岁的受惠​​者中接受 HKT 的人数显着增加，从 2005 年所有受惠者的 5.6% 大幅增加至 2021 年的 23.7%（）。研究期间的 2,022 名 HKT 患者中，372 名（18.40%）年龄≥65 岁。年龄较大的接受者更有可能是男性和白人，在 HKT 之前需要透析的人较少。Kaplan-Meier 分析显示，各队列之间未经调整的 90 天、1 年或 5 年生存率没有差异。这些发现在风险调整后仍然存在，年龄≥65 岁的一年死亡率的调整后风险为 0.91（95% CI (0.63–1.29)，）。作为一个连续变量，年龄的增加与一年死亡率无关（HR 1.01（95% CI（1.00-1.02），）每年）。年龄≥65 岁的患者出院前更频繁地需要新发透析（11.56% vs. 7.82%，）。中风率和排斥反应率相当。结论。老年接受者中的综合 HKT 正在增加，并且年龄≥65 岁不应排除 HKT。