Outcome after heart transplantation from older donor age: expanding the donor pool

There has been a progressive expansion of heart donor selection criteria, including higher age limit. We analysed the impact of using hearts from older age donors (>50 years).

Between November 2003 and December 2012, 228 heart transplantations were performed. Children and patients requiring ventricular assistance prior to transplantation were excluded. Recipients from 26 donors aged ≥ 50 years (Group A) were compared with those of 136 donors <40 years (Group B). Patient and donor criteria were identical in both groups.

Group A recipients were older than those in Group B (59 ± 11 vs 53 ± 11; P < 0.01), and tended to have more ischaemic cardiomyopathy (50 vs 35%; P = 0.16), be in intensive care (31 vs 27%; P = 0.65) and have longer waiting time (56 ± 49 vs 41 ± 47 days; P = 0.15). There were also significant differences in ischaemic time (65 ± 27 vs 93 ± 35 min; P < 0.01). Thirty-day mortality was similar (3.8 vs 3.7%; P = 0.97). Follow-up was 55 ± 32 months. Actuarial survival at 1, 3 and 5 years was 84 ± 7% for Group A and 90 ± 3, 86 ± 3 and 81 ± 4%, respectively, for Group B (P = 0.85). There were no survival differences between patients younger and older than 60 years, but there was a tendency for decreased survival free from cardiac allograft vasculopathy (CAV) in Group A compared to Group B (at 8 years 65 ± 18 vs 78 ± 7%; P = 0.06).

Parameters of exclusion of donor hearts can and must be adjusted, since the use of selected marginal donors associated with short ischaemic times appears to have no negative impact on morbidity and mortality, more importantly when compared with mortality on the waiting list.