Extended donor age in cardiac transplantation

Area of Science:

• Cardiology
• Transplantation Medicine
• Immunology

Background:

• Donor hearts from individuals over 35 are underutilized due to concerns about graft function and atherosclerosis.
• Increasing waitlist times and mortality necessitate exploring expanded donor criteria in heart transplantation.

Purpose of the Study:

• To evaluate the safety and efficacy of using donor hearts from older individuals (36-54 years) compared to younger donors (1-35 years).
• To assess early and long-term graft function and the incidence of graft atherosclerosis in recipients of older donor hearts.

Main Methods:

• Retrospective comparison of 74 heart transplant recipients receiving donors aged 36-54 (group 2) versus 159 recipients with donors aged 1-35 (group 1).
• Analysis of early postoperative graft function, graft failure rates, and long-term cardiac function via annual cardiac angiography up to 4 years.
• Assessment of graft atherosclerosis incidence in both donor age groups.

Main Results:

• Early graft function was sufficient in all group 2 recipients, contrasting with 5.7% early graft failure in group 1.
• Mean late postoperative ejection fractions were normal in both groups.
• Graft atherosclerosis incidence was similar between groups (9.8% in group 2 vs. 8.9% in group 1).

Conclusions:

• Donor hearts from individuals aged 36-54 years are safe and effective for transplantation, with outcomes comparable to younger donors.
• Expanding donor age criteria can improve organ utilization and potentially reduce waitlist mortality in heart transplantation programs.