Heart transplantation with super-aged donors older than 65 years

This study elucidated the clinical outcomes and serial allograft function of heart transplant (HTx) recipients who received hearts from super-aged donors (SAD) ≥65 years of age.

Adult HTx recipients between 1999 and 2022 were retrospectively reviewed and divided into 2: donor age ≥65 years [SAD group (n = 12)] and donor age <65 years [younger donor, YD group (n = 140)]. The primary end-point was 3-year all-cause deaths after HTx. Secondary end-points included all-cause death, hospitalization due to heart failure, acute cellular rejection, coronary intervention, and electronic device implantation. Serial cardiac function was assessed using echocardiography and right heart catheterization.

Compared with the recipients in the YD group, those in the SAD group were older [age, 60 (interquartile range (IQR): 46-63) vs 42 (IQR: 31-52) years, p < 0.001], had a higher E/e' and lower cardiac index (CI) 1 month after HTx [E/e', 12.5 (IQR: 9.0-16.8) vs 9.5 (IQR: 7.5-11.9), p = 0.026; CI, 2.8 (IQR: 2.4-3.2) liter/min/m² vs 3.3 (IQR: 2.9-3.9) liter/min/m², p = 0.014], and a comparable CI with higher E/e' 1 year after HTx [E/e', 12.0 (IQR: 8.6-13.3) vs 7.9 (IQR: 6.6-10.6), p = 0.007; CI, 3.6 (IQR: 3.2-4.3) liter/min/m² vs 3.6 (IQR: 3.3-4.2) liter/min/m², p = 0.99]. The 3-year overall survival was lower in the SAD group than in the YD group (81.5% vs 97.8%, p = 0.006), whereas the secondary end-points were comparable.

SAG hearts at ≥65 years can be used for HTx with acceptable outcomes and feasible allograft function in relatively older recipients.