Risk factors when considering heart transplants with donors aged 45 or above: Development of a Novel Mortality Risk...

Area of Science:

• Cardiology
• Transplantation Medicine
• Public Health

Background:

• Current guidelines permit donor hearts aged ≥45 if coronary artery disease is absent and ischemic time is <4 hours.
• This study investigates additional risk factors for patient survival with older donor hearts.

Purpose of the Study:

• To identify risk factors impacting patient survival in heart transplants using donors aged ≥45.
• To develop a risk score for recipients of older donor hearts.

Main Methods:

• Retrospective cohort study of adult heart transplants using donors aged ≥45 (2000-2024).
• Utilized United Network for Organ Sharing data.
• Multivariable Cox regression identified mortality risk factors.

Main Results:

• 9,843 (16.7%) of 58,859 transplants used donors ≥45 years.
• One-, 5-, and 10-year survival rates were 87.0%, 73.3%, and 53.5%.
• Significant risk factors included: ischemic time ≥4 hours, CMV-positive donor, donor cigarette use, recipient age >55, Black race, obesity, diabetes, pretransplant dialysis/ventilation, and prior cardiac surgery.

Conclusions:

• Screening for specific donor and recipient factors is vital for optimizing outcomes with older donor hearts.
• Identified risk factors include ischemic time, CMV status, donor smoking, and recipient characteristics like age, race, obesity, diabetes, and pretransplant conditions.