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The older cardiac transplant donor. Relation to graft function and recipient survival longer than 6 years
S L Mulvagh1, B Thornton, O H Frazier
1Multi-Organ Transplant Center, Methodist Hospital, Baylor College of Medicine, Houston, Texas.
Insights
Using donor hearts from individuals aged 35 or older does not negatively impact heart transplant patient survival. This finding expands the donor pool for cardiac transplantation, offering hope for more patients needing this life-saving procedure.
Area of Science:
- Cardiology
- Transplantation Medicine
- Immunology
Background:
- Traditional heart transplantation criteria favor donors under 35 years old.
- Limited donor heart availability necessitates expanding the donor pool.
- The impact of older donor hearts on cardiac transplant outcomes requires investigation.
Purpose of the Study:
- To evaluate if using donor hearts from individuals aged 35 years or older impacts cardiac transplant patient prognosis.
- To determine if older donor hearts increase the risk of graft failure due to coronary artery disease, ventricular dysfunction, or death.
Main Methods:
- Retrospective analysis of 314 heart transplants performed between 1982 and the study period.
- Classification of donors into two groups: age ≥35 years (group 1) and age <35 years (group 2).
- Comparison of recipient demographics, pre-transplant support requirements, follow-up intervals, and survival rates between the two donor age groups.
Main Results:
- Overall survival rates were comparable between group 1 (64%) and group 2 (65%).
- No significant difference in deaths attributed to coronary artery disease between the groups (18% vs 23%).
- Fewer retransplants due to coronary artery disease were observed in group 1 (0%) compared to group 2 (9%).
Conclusions:
- Donor hearts from individuals aged 35 years and older can be safely used in cardiac transplantation without adversely affecting patient survival.
- Expanding the donor pool to include older individuals is a viable strategy to address the shortage of donor hearts.
- This study supports revising donor selection criteria to improve access to heart transplantation.
Abstract:
A donor age of less than 35 years has long been considered crucial for heart transplantation. Because of limited donor heart supply and increasing demand for cardiac transplants, we attempted to expand the donor pool by using hearts from older individuals. This study was designed to determine if older donor hearts adversely affected cardiac transplant patient prognosis by predisposing them to graft failure from coronary artery disease, ventricular dysfunction, or death. Since 1982, 314 heart transplants have been performed at our institutions. Potential donors were deemed fit if there was no history of heart disease, the chest x-ray film was normal, the electrocardiogram showed nonspecific changes only, and blood pressure was maintained without major pharmacological support. In 47 (15%), donor age was 35 years or greater (group 1: mean age, 39 years; range, 35-49 years). In 267 (85%), donor age was less than 35 years (group 2: mean age, 23 years; range, 2-34 years). Mean group 1 recipient age was 55 years (range, 39-68 years) compared with 46 years (range, 0.7-66 years) in group 2 (p less than 0.01). Pretransplant inotropic support, mechanical support, or both were required in 15 (33%) group 1 patients and in 41 (16%) group 2 patients (p less than 0.01). Group 1 and 2 follow-up intervals were 1.1 +/- 1.0 and 1.8 +/- 1.4 years (mean +/- SD), respectively (p less than 0.0001). Overall survival was 64% versus 65%, group 1 versus group 2, and life table analysis showed no significant difference between the groups. There were three of 17 (18%) deaths due to coronary artery disease in group 1 and 20 of 87 (23%) in group 2 (p = NS). Seven patients in group 2 and none in group 1 required retransplant because of coronary artery disease.(ABSTRACT TRUNCATED AT 250 WORDS)