Heart Transplantation With Older Donors: Should There Be an Age Cutoff?

Area of Science:

• Cardiology
• Transplantation Medicine
• Geriatric Cardiology

Background:

• Heart transplantation is vital but limited by donor organ availability.
• The use of older donor hearts (≥55 years) is debated due to potential outcome disparities.
• Optimizing donor pool utilization is crucial for meeting transplant demand.

Purpose of the Study:

• To compare heart transplant outcomes between recipients of donor hearts aged ≥55 years and those aged <55 years.
• To evaluate the impact of donor age on short- and long-term graft survival and adverse events.
• To assess the viability of utilizing older donor hearts in specific recipient populations.

Main Methods:

• Retrospective review of first-time adult heart transplant recipients (2010-2019).
• Analysis of endpoints including 30-day, 1-, 3-, and 5-year survival, freedom from cardiac allograft vasculopathy, and major adverse cardiac events.
• Statistical analysis using Cox proportional hazards modeling, propensity score matching, and Kaplan-Meier survival analysis.

Main Results:

• In unmatched cohorts, no significant survival differences were observed at any time point.
• Recipients of older donor hearts (≥55 years) showed lower freedom from cardiac allograft vasculopathy and fatal major adverse cardiac events.
• Propensity-matched analysis revealed similar survival and freedom from cardiac allograft vasculopathy, but significantly lower freedom from nonfatal major adverse cardiac events at 1, 3, and 5 years for recipients of older donors.

Conclusions:

• Carefully selected older donors can be considered for specific recipient groups.
• Outcomes are acceptable, but careful patient selection is paramount.
• Increased risk of nonfatal adverse events warrants consideration in recipients of older donor hearts.