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Updated: May 18, 2026
A High-Fidelity Porcine Model of Orthotopic Heart Transplantation Following Donation after Circulatory Death
Published on: June 6, 2025
Risk factor analysis of late survival after heart transplantation according to donor profile: a multi-institutional
A I Fiorelli1, J N Branco, J J Dinkhuysen
1Heart Institute of Sao Paulo University Medical School, Sao Paulo, Brazil. fiorelliai@uol.com.br
Insights
Donor age over 40 significantly impacts heart transplant survival rates. Organs from older donors are associated with lower long-term patient survival, highlighting age as a critical factor in heart transplantation outcomes.
Area of Science:
- Cardiology
- Transplantation Medicine
- Organ Donation
Background:
- Increasing incidence of terminal heart failure outpaces organ availability, leading to high mortality rates for patients on waiting lists.
- The shortage of donor hearts necessitates the increased use of marginal and expanded criteria donors.
Purpose of the Study:
- To analyze donor profiles and recipient risk factors in heart transplantations (HTx) within Sao Paulo state over an 8-year period.
- To identify key factors influencing survival rates following heart transplantation.
Main Methods:
- A multi-institutional retrospective review of all HTx data in Sao Paulo, Brazil, from 2002 to 2008.
- Analysis included 1777 potential heart donors, with 512 accepted for transplantation, including nonstandard donors.
Main Results:
- Hospital mortality was 27.9%, with a 6-year survival rate of 55.5% after HTx.
- Multivariate analysis identified donor age as a significant factor impacting survival.
- Organs from donors older than 40 years were associated with significantly lower late survival rates (P = .0032).
Conclusions:
- Donor age exceeding 40 years is a critical risk factor for reduced long-term survival after heart transplantation.
- Donor gender and the use of norepinephrine in donors did not negatively affect early survival outcomes.
Introduction:
Patients with terminal heart failure have increased more than the available organs leading to a high mortality rate on the waiting list. Use of Marginal and expanded criteria donors has increased due to the heart shortage.
Objective:
We analyzed all heart transplantations (HTx) in Sao Paulo state over 8 years for donor profile and recipient risk factors.
Method:
This multi-institutional review collected HTx data from all institutions in the state of Sao Paulo, Brazil. From 2002 to 2008 (6 years), only 512 (28.8%) of 1777 available heart donors were accepted for transplantation. All medical records were analyzed retrospectively; none of the used donors was excluded, even those considered to be nonstandard.
Results:
The hospital mortality rate was 27.9% (n = 143) and the average follow-up time was 29.4 ± 28.4 months. The survival rate was 55.5% (n = 285) at 6 years after HTx. Univariate analysis showed the following factors to impact survival: age (P = .0004), arterial hypertension (P = .4620), norepinephrine (P = .0450), cardiac arrest (P = .8500), diabetes mellitus (P = .5120), infection (P = .1470), CKMB (creatine kinase MB) (P = .8694), creatinine (P = .7225), and Na+ (P = .3273). On multivariate analysis, only age showed significance; logistic regression showed a significant cut-off at 40 years: organs from donors older than 40 years showed a lower late survival rates (P = .0032).
Conclusions:
Donor age older than 40 years represents an important risk factor for survival after HTx. Neither donor gender nor norepinephrine use negatively affected early survival.
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