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Extending cardiac allograft ischemic time and donor age: effect on survival and long-term cardiac function
P W Pflugfelder1, N R Singh, F N McKenzie
1Department of Medicine (Division of Cardiology), University of Western Ontario, University Hospital, London, Canada.
Insights
Extending donor age and cardiac allograft ischemic time in heart transplantation did not increase graft loss or impair cardiac function. Careful donor selection allows for a larger donor pool without compromising patient outcomes.
Area of Science:
- Cardiology
- Transplantation Medicine
- Immunology
Background:
- Cardiac allograft ischemic time and donor age are critical factors in heart transplantation.
- Previous concerns existed regarding the impact of extended ischemic times and older donor ages on graft survival and function.
Purpose of the Study:
- To investigate the relationship between cardiac allograft ischemic time, donor age, and early outcomes in heart transplant recipients.
- To determine if extended donor age and ischemic time impact 90-day graft loss and cardiac function.
Main Methods:
- Retrospective analysis of 219 heart transplant patients with at least 3 months follow-up.
- Assessment of cardiac allograft ischemic time and donor age in relation to graft loss.
- Evaluation of cardiac function using treadmill exercise, radionuclide angiography, and hemodynamic assessments at 3 and 12 months.
Main Results:
- No significant relationship was found between donor age or ischemic time and 90-day graft loss.
- Cardiac function at 3 and 12 months post-transplant was not adversely affected by donor age or ischemic time.
- In 1989, 39% of donors were 35+ years old, and 18% were 45+ years old, with longer ischemic times also increasingly utilized.
Conclusions:
- Careful selection of appropriate donors can safely extend graft ischemic time and donor age.
- Expanding the donor pool through these criteria has not been associated with increased graft loss or adverse cardiac function.
- This approach enhances the potential donor pool for heart transplantation without compromising short-to-intermediate term outcomes.
Abstract:
Of 219 heart transplant patients with follow up for at least 3 months after transplantation, cardiac allograft ischemic time was more than 4 hours in 28% and more than 5 hours in 10%. In 1988 and 1989 grafts with ischemic times longer than 4 hours were used in 44% and 45% of cases, respectively. Overall, donor age has been 35 or more years in 22% and 45 or more in 9%. In 1989 donor age was 35 or more years in 39% of cases and 45 or more in 18%. Fifteen of 20 grafts from donors 45 years or older were used for patients aged 50 or older. There was no relationship between donor age or ischemic time and 90-day graft loss. At 3 and 12 months, cardiac function, assessed by treadmill exercise duration, radionuclide angiography, and rest and peak supine exercise hemodynamics, was also unrelated to donor age or ischemic time. Therefore by careful selection of appropriate donors, extending both graft ischemic time and donor age has increased the potential donor pool and has not to date been associated with increased graft loss or adverse effects on cardiac function 3 months and 1 year after heart transplantation.
