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The policy of placing older donors into older recipients: is it worth the risk?
Yonah Solaiman Tehrani1, Zhe Yu, Minh Luu
1Cedars-Sinai Heart Institute, Los Angeles, CA, USA.
Insights
Using older donor hearts (≥50 years) in older heart transplant recipients (≥60 years) significantly reduces five-year survival and freedom from cardiac allograft vasculopathy (CAV). Caution is advised for these high-risk transplants.
Area of Science:
- Cardiology
- Transplantation Medicine
- Geriatric Medicine
Background:
- Older donor hearts (≥50 years) are increasingly utilized to expand the donor pool for older recipients (≥60 years).
- Both older recipients and those receiving older donor hearts face independently reduced post-transplant survival.
- The combined effect of older donors and recipients on heart transplant outcomes remains a subject of debate.
Purpose of the Study:
- To investigate the impact of using older donor hearts (≥50 years) on outcomes in older heart transplant recipients (≥60 years).
- To compare five-year survival, cardiac allograft vasculopathy (CAV), major adverse cardiac events (NF-MACE), and rejection rates between groups.
Main Methods:
- Retrospective analysis of 879 heart transplant patients (2000-2010), excluding those with donor coronary artery disease.
- Focus on 380 recipients aged ≥60 years, comparing 53 patients receiving donors ≥50 years with 327 receiving donors <50 years.
- Evaluation of five-year survival, freedom from CAV (stenosis ≥30%), NF-MACE (MI, CHF, stroke, pacemaker/ICD), and one-year freedom from treated rejection.
Main Results:
- The older donor group (≥50 years) showed significantly lower five-year survival (57% vs. 85%, p < 0.001) and freedom from CAV (83% vs. 92%, p = 0.03) compared to the younger donor group.
- No significant differences were found in five-year freedom from NF-MACE or one-year freedom from treated rejection.
- Multivariate analysis identified donor age ≥50 years as an independent risk factor for death (HR 1.8) and CAV (HR 1.9).
Conclusions:
- The use of older donor hearts (≥50 years) in older recipients (≥60 years) is associated with diminished five-year survival and increased risk of cardiac allograft vasculopathy.
- Careful consideration and patient selection are crucial when matching older donors with older heart transplant recipients.
- Further large-scale studies are recommended to validate these findings and refine clinical decision-making.
Background:
To expand the donor pool, older donors (≥50 yr) are frequently used in older recipients (≥60 yr). Older recipients and those receiving older donor hearts have independently displayed decreased post-transplant survival. However, outcomes in older patients receiving older donor hearts are contentious.
Methods:
Eight hundred and seventy-nine heart transplant patients between 2000 and 2010 were analyzed, excluding patients with donor coronary artery disease. From 380 patients ≥60 yr, 327 patients with donors <50 yr old were compared with 53 patients with donors ≥50 yr old for: five-yr actuarial survival, freedom from cardiac allograft vasculopathy (CAV: stenosis ≥30%), non-fatal major adverse cardiac events (NF-MACE: MI, CHF, stroke, need for pacemaker/ICD), one-yr freedom from any treated rejection.
Results:
The older vs. younger donor group demonstrated significantly lower five-yr survival (57% vs. 85%, p < 0.001) and freedom from CAV (83% vs. 92%, p = 0.03). No difference was observed in five-yr freedom from NF-MACE and one-yr freedom from any treated rejection. Multivariate analysis found donor age ≥50 to be an independent risk factor for death (HR 1.8, CI 1.1-2.9, p = 0.008) and CAV (HR 1.9, CI 1.2-2.9, p = 0.004).
Conclusions:
Use of older donors (≥50 yr) in older recipients (≥60 yr) results in lower five-yr survival and freedom from CAV. Caution is required in these cases. Larger studies are warranted to confirm findings.
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