Midterm Outcomes and Early Hemodynamic Findings After Heart Transplantation Using Donors Aged ≥50 Years

Expanding the donor age limit may be necessary due to persistent donor shortages. The hemodynamic characteristics and postoperative cardiac performance of hearts from older donors remain insufficiently understood. This study aimed to evaluate midterm outcomes and early hemodynamic changes in recipients of hearts from older donors.

This retrospective observational study analyzed data from 260 patients who underwent heart transplantation between 1999 and 2022 at two institutions. Outcomes were compared between 89 recipients of hearts from donors aged ≥50 years (D-age ≥ 50) and 171 recipients from donors aged <50 years (D-age < 50). The endpoint included overall survival rate, rehospitalization for cardiac events, and early postoperative hemodynamic data.

Ten-year survival rates did not significantly differ between the two groups (90.6% vs 89.4%, P = .26). Recipients of hearts from older donors required extracorporeal membrane oxygenation more frequently than those receiving hearts from younger donors (2% vs 11%, P = .001). Early hemodynamic evaluation showed a lower cardiac index in recipients of hearts from donors aged ≥50 years, suggesting impaired early diastolic function. The rate of rehospitalization for cardiac events was comparable between the D-age ≥ 50 and D-age < 50 groups; however, donor age was independently associated with rehospitalization risk.

Although the potential increase in extracorporeal membrane oxygenation use due to early diastolic dysfunction and the higher rate of cardiac-related rehospitalization should be noted, the midterm outcomes for recipients of hearts from donors aged ≥50 years were comparable to those of recipients receiving hearts from younger donors.