Increased mortality when combining older donors and recipients in heart transplantation

The utilization of hearts from older donors has increased, particularly for older recipients. However, the impact of older donor hearts on recipients of different ages is less known.

To determine the impact of older donor hearts on post-transplant outcomes across different recipient age groups.

The Organ Procurement and Transplant Network database was queried from 2006 to March 2024. Four groups were created stratifying by donor age (> 55 years) and recipient age (> 60 years). Kaplan-Meier curves and Cox regression models were used.

One thousand fifty out of 39868 transplants (2.6%) were performed utilizing hearts from older donors. The rate of older donor hearts in younger recipients was only 1.8%, while the older donor hearts were used 4.0% in older recipients (P < 0.001). Old donor/old recipient and young donor/old recipient combinations were associated with post-transplant mortality [hazard ratio (HR): 1.64 (95%CI: 1.42-1.90) and 1.42 (95%CI: 1.34-1.51)], while old donor/young recipient was not. Within each recipient age group, the older recipient groups showed greater differences in 1- and 5-year survival probabilities (80.4% and 67.4% with old donors, 89.2% and 76.8% with young donors) than younger recipient groups (90.3% and 77.5% with old donors, 92.2% and 80.3% with young donors).

This study demonstrates the higher utilization of older donor hearts (aged more than 55) in older recipients. Paradoxically, the combination of older donor hearts with older recipients is associated with a higher risk of mortality. However, these organs remain valuable options across all recipient age groups in current context of organ shortage.