Donor‐recipient age interaction and the impact on clinical results after heart transplantation

Abstract

To evaluate the impact of donor‐recipient age matching on clinical outcomes after heart transplantation, a total of 509 patients (January 1990‐December 2018, mean follow‐up 111 ± 80 months) were stratified into 4 groups (young‐R/young‐D, young‐R/old‐D, old‐R/young‐D, old‐R/old‐D) according to the recipient (young‐R < 60, old‐R ≥ 60 years) and the donor (young‐D < 50, old‐D ≥ 50 years) age. No difference was found among 30‐day mortality (P = .11) and postoperative complications between groups. Both unadjusted and adjusted survival was significantly higher for group young‐R/young‐D than that of other groups, in which survival was similar [adjusted HR for mortality of 2.0(1.2‐3.4), 2.1(1.4‐3.8) and 2.5(1.6‐4.1) for groups old‐R/young‐D, young‐R/old‐D, old‐R/old‐D, respectively]. Compared to other groups, the incidence of grade ≥ 2 CAV was significantly lower in old‐R/young‐D group [adjusted HR 0.4(0.2‐0.7)]. Among young recipients, the rate of acute grade ≥ 2 rejection episodes was higher in those receiving an old donor graft (P = .04). Old recipient groups were more affected by neoplasms and severe renal failure than young recipient groups (P < .01). Employment of hearts from donors ≥50 years of age adversely affects survival in recipients <60 years of age but does not influence outcomes in older recipients. Also, donor and recipient ages seem to have opposite effects on incidence of rejections and CAV of high grade.

Heart Transplantation of the Elderly—Old Donors for Old Recipients: Can We Still Achieve Acceptable Results?

“…However, we already observed this for the very short-term survival. In addition, donor age is also a strong and independent risk factor for primary graft dysfunction, which we did not observe [12][13][14][15].…”

“…It was no surprise that patients of the D Y /R Y group had the best outcome as this has been reported in several previous studies [14][15][16][17] Nevertheless, the implications of these results represent some kind of ethical dilemma. First, young donors should be allocated to every recipient, as this was best for all recipient ages.…”

Influence of donor‐transmitted coronary artery disease on long‐term outcomes after heart transplantation ‐ a retrospective study

“…In the attempt to expand the donor pool, the average age of heart donors is steadily increasing, particularly in Europe [2]. Although our institutional policy favors the matching of the older donor hearts with the older recipients, due to donor shortage the employment of older grafts has become widely considered as a standard option, also in younger recipients, and not necessarily in critical clinical condition [14]. Despite this trend may lead to a higher prevalence of preexisting donor coronary atherosclerosis, a largely adopted protocol aimed to detect and manage donor CAD is still lacking.…”

The impact of the distance between patient residency and heart transplant center on outcomes after heart transplantation

“…Follow‐up information was obtained from our institutional database and patient charts, updated during post‐HTx controls. The postoperative and follow‐up protocols used have been detailed previously 15 . Particularly, endomyocardial biopsies were performed monthly up to the first post‐HTx year and thereafter when required.…”