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Evaluating the donor pool: impact of using hearts from donors over the age of 49 years
P Mercer1, L Sharples, J Edmunds
1Transplant Unit, Papworth Hospital, Cambridge, UK.
Insights
Using hearts from donors over 49 years old for transplantation shows similar survival and morbidity rates compared to younger donors. However, older donor hearts increase the risk of cardiac allograft vasculopathy, necessitating careful long-term patient follow-up.
Area of Science:
- Cardiology
- Transplantation Medicine
- Geriatric Medicine
Background:
- Shortage of donor hearts necessitates using organs from older individuals.
- Careful selection of older donors (over 49) has been employed since 1988.
- Impact of older donor hearts on patient outcomes requires evaluation.
Purpose of the Study:
- To assess the impact of using hearts from donors over 49 years of age on patient morbidity and mortality.
- To compare outcomes between heart transplant recipients receiving organs from older versus younger donors.
Main Methods:
- Retrospective analysis of 400 first heart transplants performed between May 1988 and August 1996.
- Comparison of outcomes between 35 recipients of organs from donors over 49 (group 1) and 365 recipients from younger donors (group 2).
- Evaluation of survival rates, intensive care unit and hospital stay, rejection episodes, infection rates, and development of coronary artery disease.
Main Results:
- No significant differences in one-year (79% vs. 82%) or five-year (69% vs. 67%) survival rates.
- Similar intensive care unit and hospital stay durations between groups.
- Higher prevalence of coronary artery disease at 2 years post-transplant in recipients of older donor hearts (23% vs. 9%, P < 0.005).
Conclusions:
- Heart transplantation using donors aged 49 and over is associated with comparable short-term survival and morbidity.
- Older donor hearts present a significantly higher risk of cardiac allograft vasculopathy.
- Long-term follow-up is crucial for patients receiving organs from older donors to monitor for late complications.
Abstract:
The shortage of hearts for transplantation has led to the use of organs from older donors in many centres. Despite the lack of coronary angiography on potential organ donors, hearts from carefully selected donors over 49 years of age have been used at this centre since 1988. In the study reported here looked at the impact of this strategy on morbidity and mortality. Between May 1988 and August 1996, 400 first heart transplants were performed, 35 recipients (31 male, 4 female; age 51 +/- 5.9 years) received hearts from donors over 49 years of age (group 1) while 365 (310 male, 55 female; age 49 +/- 9.7 years) had younger donors (group 2). The mean ischaemic time was 189 min (+/- 63.1) in group 1 and 180 min (+/- 59.2) in group 2 (n.s.). The main aetiology of heart failure in groups 1 and 2 was coronary artery disease in 46% and 51%, and dilated cardiomyopathy in 40% and 45% respectively (n.s.). There were no differences in the duration of stay on the intensive care unit or in hospital between the groups. One-year survival was 79% in group 1 and 82% in group 2 (n.s.) and actuarial 5-year survival 69% and 67%, respectively. Six patients in group 1 (17%) and 45 patients in group 2 (12%) died in the first 3 months; of these primary donor organ failure accounted for 50% in group 1 and 13.3% in group 2 (n.s.). Episodes of acute rejection (in the first 3 months) were similar in the two groups: 1.4 and 1.6 per 100 patient days, respectively. Infection rates were also similar: 0.5 and 0.6 per 100 patient days, respectively. The prevalence of coronary artery disease on surveillance coronary angiography at 2 years was 23% in group 1 and 9% in group 2 (P < 0.005). There was a greater proportion of CMV antibody donors in the older donor group, but the association between donor age and coronary artery disease persisted after adjusting for CMV status in multivariate analysis. Too few patients underwent angiography thereafter for valid comparisons. In summary, recipients of organs from donors aged 49 years and over can expect comparable survival rates and morbidity levels to recipients of organs from younger donors, at least in the first 2 years postoperation. There is evidence that older donors confer a significantly higher risk of cardiac allograft vasculopathy which may result in a greater attrition rate thereafter. Careful follow-up of these patients after 2 years is required.