# Case Report: Cardiac transplantation in a 76-year-old recipient: moving from anagraphic to biological age under a geriatric perspective

## TL;DR

This case report shows that a 76-year-old man successfully received a heart transplant and recovered well, suggesting age alone should not disqualify patients.

## Contribution

The novelty lies in demonstrating successful heart transplantation in the oldest documented recipient, challenging age-based eligibility norms.

## Key findings

- The patient had an uneventful postoperative course and was discharged on day 30.
- At 14 months post-transplant, the patient showed improved heart function with no signs of rejection.
- This case suggests that well-selected elderly patients can benefit from heart transplants.

## Abstract

Heart transplantation remains the definitive treatment for end-stage heart failure. However, donor shortages and the increasing age of candidates present significant challenges. This report aims to highlight the feasibility and successful outcome of heart transplantation in an elderly patient, questioning traditional age-based eligibility criteria.

A 76-year-old male with idiopathic dilated cardiomyopathy and severe heart failure underwent orthotopic heart transplantation. Preoperative assessments included right heart catheterization, echocardiography, and cardiac index evaluation. A suitable 66-year-old female donor was identified, and transplantation was performed using the bicaval technique. Postoperative outcomes were monitored through echocardiography and biopsy analysis.

The patient had an uneventful postoperative course, with extubation on day 1 and discharge on postoperative day 30. Follow-up at 14 months showed excellent clinical recovery, with an improved left ventricular ejection fraction (LVEF) of 58% and global longitudinal strain (GLS) of −20.8%. No signs of rejection were observed on biopsy.

This case represents the oldest documented successful heart transplant recipient discharged home. The findings suggest that age alone should not be a limiting factor in transplantation eligibility. Expanding criteria to include well-selected elderly patients could help address the growing demand for donor hearts.

Timeline of the clinical course of a 76-year-old heart transplant recipient.