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Outcomes of patients undergoing transplantation with older donor hearts
D C Drinkwater1, H Laks, A Blitz
1Division of Cardiothoracic Surgery, University of California, Los Angeles, USA.
Insights
Using older donor hearts, including bypassed hearts, for transplantation shows similar survival rates and transplant-associated coronary artery disease development compared to younger donors. This expands the pool of suitable donor hearts for patients awaiting transplants.
Area of Science:
- Cardiology
- Transplant Surgery
- Organ Donation
Background:
- Limited donor hearts create inequity in heart transplantation.
- Expanding donor acceptance criteria for age and condition is an immediate solution.
- This review examines outcomes using older donor hearts, including bypassed ones.
Purpose of the Study:
- To compare early and late results of heart transplantation using older donor hearts versus younger donor hearts.
- To assess the safety and efficacy of using simultaneously bypassed donor hearts.
- To evaluate survival rates, graft function, and incidence of transplant-associated coronary artery disease.
Main Methods:
- Retrospective review of 52 patients receiving older donor hearts (>45 years) from April 1987 to September 1994.
- Comparison with 324 recipients of younger donor hearts (<45 years).
- Assessment of survival, graft function, infection, rejection, and coronary artery disease using echocardiography, coronary angiography, and intravascular ultrasonography.
Main Results:
- One-year actuarial survival was 84% for the older donor group and similar 5-year survival between older and younger donor groups.
- The bypassed donor subgroup showed 60% 1-year survival.
- Left ventricular function, infection, rejection, and transplant-associated coronary artery disease incidence were comparable between groups up to 5 years.
Conclusions:
- Older donor hearts, including bypassed ones, yield similar early and late survival outcomes to younger donor hearts.
- No significant difference in transplant-associated coronary artery disease development was observed.
- Utilizing older donors can immediately increase the availability of suitable hearts for transplantation.
Background:
The limited number of donor hearts relative to the number of waiting recipients is the major determinate of a growing inequity. Although a number of potential options are being vigorously pursued, the most effective immediate solution is to expand acceptance criteria for donor age and medical condition. This report is a review of our early and late results with the use of older donors, including simultaneously "bypassed" donor hearts.
Methods:
Between April 1987 and September 1994, 52 patients received older donor hearts (older than 45 years) with a mean donor age of 51 years. Ten patients in this group received hearts simultaneously bypassed with from 1 to 4 grafts per patient. Donor and recipient age, diagnosis, and HLA match were compared between the older donor group and a contemporaneous younger (younger than 45) donor group (N = 324). Also compared was actuarial survival at up to 5 years of follow-up in addition to graft function, bypass graft patency, infection and rejection incidence at 1 year, and the prevalence of transplant-associated coronary artery disease in the two groups. Echocardiography, coronary angiography, and intravascular coronary ultrasonography were used for this assessment.
Results:
One-year actuarial survival was 84% for the older donor group, which included 19 status 1 patients (survival 76%) and 23 status II patients (survival 90%). In the bypassed donor subgroup there was a 60% 1-year actuarial survival with 5 status 1 patients (survival 80%) and 5 status II patients (survival 40%). At 1 year, left ventricular function and the incidence of infection and rejection were equal between these two donor groups. Five-year actuarial survivals were the same between the overall older and younger donor groups. Finally, the development of transplant-associated coronary disease was similar in both groups up to 5 years after transplantation.
Conclusions:
This initial review of heart transplantation with older donor hearts, including bypassed hearts, demonstrates similar early and late survival outcomes as compared with those of a contemporaneous younger donor group. Significantly, there appears to be no difference in the development of transplant-associated coronary artery disease during the follow-up period. The older donor represents a potential immediate increase in the number of suitable hearts for transplantation. Bypassed donor hearts represent a small but potentially significant subgroup that may be safely and effectively used when appropriately matched to the recipient by age and medical condition. Greater experience, particularly with this bypassed group, will help determine optimal donor-to-recipient matching for the future.