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Published on: June 24, 2014
Medium-term results of heart transplantation using donors over 63 years of age
E V Potapov1, M Loebe, M Hübler
1Deutsches Herzzentrum Berlin, Germany.
Insights
Using older donor hearts for heart transplantation (HTx) showed similar survival rates but increased cardiac morbidity and cytomegalovirus infection risk. Careful donor selection and monitoring are key for successful HTx with older hearts.
Area of Science:
- Cardiology
- Transplantation Medicine
- Geriatric Cardiology
Background:
- Continual shortage of donor hearts necessitates expanding the donor pool.
- Older donor hearts (over 63 years) are increasingly utilized for heart transplantation (HTx).
- Comparison of medium-term outcomes between younger and older donor hearts is crucial.
Purpose of the Study:
- To compare medium-term follow-up of patients undergoing HTx with older donor hearts versus younger donor hearts.
- To evaluate the impact of donor age on post-transplant outcomes, including survival, morbidity, and infection rates.
Main Methods:
- Retrospective analysis of 309 adult HTx recipients from April 1994 to November 1998.
- Patients divided into two groups: Group I (donor age <63 years) and Group II (donor age >63 years).
- Analysis included ejection fraction, early mortality, survival rates, cardiac morbidity, cytomegalovirus infection, and acute rejection episodes.
Main Results:
- No significant difference in early postoperative mortality or cumulative survival rates between groups.
- Long-term cardiac morbidity was significantly higher in Group II (older donors).
- Freedom from cytomegalovirus infection was significantly lower in Group II, while freedom from severe rejection was similar.
Conclusions:
- Accepting donors over 63 years for HTx does not worsen recipient long-term survival.
- Increased cardiac morbidity (coronary stenosis) and lower freedom from cytomegalovirus infection observed with older donors.
- Careful selection and monitoring of older donors, alongside revascularization strategies, can make HTx with older hearts a safe option.
Background:
The continual shortage of hearts for transplantation (HTx) led to the expansion of the donor pool by accepting older donors. We compared the medium-term follow-up of patients after HTx with older hearts (over the age of 63 years) with those of patients after HTx with younger hearts.
Patients And Methods:
Since April 1994 we have used hearts for HTx from donors older than the age of 63 years. Until November 1998, 309 HTx and 9 re-HTx were performed in 309 adults with a mean age of 50.7+/-10.9 years (range 17-68 years). There were 252 men and 57 women. The patients were divided into two groups: group I--donor age under 63 years (296 patients, mean age 50.4+/-11 years; mean donor age 38.1+/-13 years; mean follow-up 1.7+/-1.6 years); group II-donor age of more than 63 years (13 patients, mean age 57.4+/-5.6 years; mean donor age 65.1+/-2.1; mean follow-up 2.2+/-1.6 years). There were no differences in the etiology of heart failure, gender, or ischemia time between the groups. The patients in group II were significantly older (P = 0.008). Multiple factors were analyzed in the groups, which included changes in the left/right ventricle ejection fraction, early postoperative mortality (up to 30 days), cumulative survival rates and cardiac-dependent morbidity [myocardial infarction, malignant arrhythmias, coronary stenosis (>50% in one of the main coronary arteries) and transplant vasculopathy]. Additionally, freedom from cytomegalovirus infection (rise of titer or seroconversion) and freedom of acute rejection episodes grade > or =2 (International Society of Heart & Lung Transplantation [ISHLT]) were analyzed.
Results:
After 1 year mean left and right ventricle ejection fraction were good in both groups and did not significantly change for up to 2 years. No Re-HTx was performed in group II. The early postoperative mortality was similar in both groups (P = 0.8). Also, the cumulative survival rates were similar in both groups (P = 0.87). Long-term cardiac morbidity was lower in group I (P = 0.03). The long-term freedom from cytomegalovirus infection in group I was significantly higher when compared with group II (P = 0.0002). The long-term freedom from severe rejection episodes was similar in both groups (P = 0.3)
Conclusion:
The study found a significant increase in long-term cardiac morbidity due to more focal coronary stenosis in group II, and freedom from cytomegalovirus infection, but did not find significant differences in the long-term survival between patients who received hearts from donors of up to 63 years of age and from those more than 63 years. The acceptance of donors older than 63 years old for HTx does not worsen the outcome of the recipients. The careful selection of older donors, with close monitoring of the coronary situation after HTx and expanded indications for revascularization of older hearts, could make HTx with older hearts, even in older recipients, a safe option.
