Heart Transplantation With Older Donors: Should There Be an Age Cutoff?

Heart transplantation remains limited by donor availability. Currently, only some programs accept older donors, and their use remains contentious. We compared outcomes of heart transplant recipients who received donor hearts ≥55 years with those who received donor hearts

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Published in:Transplantation proceedings 2022-10, Vol.54 (8), p.2088-2096
Main Authors: Chen, Qiudong, Kobashigawa, Jon, Emerson, Dominic, Singer-Englar, Tahli, Megna, Dominick, Ramzy, Danny, Catarino, Pedro, Trento, Alfredo, Chikwe, Joanna, Kittleson, Michelle, Esmailian, Fardad
Format: Article
Language:English
Subjects:
Adult
Age Factors
Heart Diseases - etiology
Heart Transplantation - adverse effects
Humans
Kaplan-Meier Estimate
Middle Aged
Retrospective Studies
Tissue Donors
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cited_by cdi_FETCH-LOGICAL-c436t-bbe5ea9ab5a2e71e1757387615fe2ec5c6747889fc9799721d01625c357ab2153
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container_issue 8
container_start_page 2088
container_title Transplantation proceedings
container_volume 54
creator Chen, Qiudong
Kobashigawa, Jon
Emerson, Dominic
Singer-Englar, Tahli
Megna, Dominick
Ramzy, Danny
Catarino, Pedro
Trento, Alfredo
Chikwe, Joanna
Kittleson, Michelle
Esmailian, Fardad
description Heart transplantation remains limited by donor availability. Currently, only some programs accept older donors, and their use remains contentious. We compared outcomes of heart transplant recipients who received donor hearts ≥55 years with those who received donor hearts
doi_str_mv 10.1016/j.transproceed.2022.07.004
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Currently, only some programs accept older donors, and their use remains contentious. We compared outcomes of heart transplant recipients who received donor hearts ≥55 years with those who received donor hearts &lt;55 years. Records of first-time adult heart transplant recipients between 2010 and 2019 were reviewed. Endpoints included 30-day and 1-, 3-, and 5-year survival; freedom from cardiac allograft vasculopathy; freedom from nonfatal major adverse cardiac events; and freedom from any rejections. The effect of donor age ≥55 years was analyzed with Cox proportional hazards modeling, 1:2 propensity score matching, and Kaplan-Meier survival analysis. Sixty-six patients received donor hearts ≥55 years and 766 received donor hearts &lt;55 years. In the unmatched cohort, there was no significant difference in survival between the 2 groups at 30 days (93.9% vs 97.3%, P = .127), 1 year (87.9% vs 91.6%, P = .325), 3 years (86.4% vs 86.5%, P = .888), or 5 years (78.8% vs 83.8%, P = .497). The ≥55 years group had a significantly lower freedom from cardiac allograft vasculopathy and fatal major adverse cardiac events. In propensity-matched patients, recipients of donors ≥55 years had similar survival and freedom from cardiac allograft vasculopathy but significantly lower 1-year (76.7% vs 88.3%, P = .026), 3-year (68.3% vs 84.2%, P = .010), and 5-year (63.3% vs 83.3%, P = .002) freedom from nonfatal major adverse cardiac events when compared to recipients of younger donors. Carefully selected older donors can be considered for a carefully selected group of recipients with acceptable outcomes.</description><identifier>ISSN: 0041-1345</identifier><identifier>EISSN: 1873-2623</identifier><identifier>DOI: 10.1016/j.transproceed.2022.07.004</identifier><identifier>PMID: 36192208</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Age Factors ; Heart Diseases - etiology ; Heart Transplantation - adverse effects ; Humans ; Kaplan-Meier Estimate ; Middle Aged ; Retrospective Studies ; Tissue Donors</subject><ispartof>Transplantation proceedings, 2022-10, Vol.54 (8), p.2088-2096</ispartof><rights>2022 Elsevier Inc.</rights><rights>Copyright © 2022 Elsevier Inc. 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Currently, only some programs accept older donors, and their use remains contentious. We compared outcomes of heart transplant recipients who received donor hearts ≥55 years with those who received donor hearts &lt;55 years. Records of first-time adult heart transplant recipients between 2010 and 2019 were reviewed. Endpoints included 30-day and 1-, 3-, and 5-year survival; freedom from cardiac allograft vasculopathy; freedom from nonfatal major adverse cardiac events; and freedom from any rejections. The effect of donor age ≥55 years was analyzed with Cox proportional hazards modeling, 1:2 propensity score matching, and Kaplan-Meier survival analysis. Sixty-six patients received donor hearts ≥55 years and 766 received donor hearts &lt;55 years. In the unmatched cohort, there was no significant difference in survival between the 2 groups at 30 days (93.9% vs 97.3%, P = .127), 1 year (87.9% vs 91.6%, P = .325), 3 years (86.4% vs 86.5%, P = .888), or 5 years (78.8% vs 83.8%, P = .497). The ≥55 years group had a significantly lower freedom from cardiac allograft vasculopathy and fatal major adverse cardiac events. In propensity-matched patients, recipients of donors ≥55 years had similar survival and freedom from cardiac allograft vasculopathy but significantly lower 1-year (76.7% vs 88.3%, P = .026), 3-year (68.3% vs 84.2%, P = .010), and 5-year (63.3% vs 83.3%, P = .002) freedom from nonfatal major adverse cardiac events when compared to recipients of younger donors. Carefully selected older donors can be considered for a carefully selected group of recipients with acceptable outcomes.</description><subject>Adult</subject><subject>Age Factors</subject><subject>Heart Diseases - etiology</subject><subject>Heart Transplantation - adverse effects</subject><subject>Humans</subject><subject>Kaplan-Meier Estimate</subject><subject>Middle Aged</subject><subject>Retrospective Studies</subject><subject>Tissue Donors</subject><issn>0041-1345</issn><issn>1873-2623</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><recordid>eNqNUctu2zAQJIoWjZP0Fwoip16k8iGKUi5BYqd2gQA5xEWPBEWtYhqy6JCUgf596doNnFtOCy5nZ3ZnELqiJKeElt_XefR6CFvvDECbM8JYTmROSPEBTWglecZKxj-iSerQjPJCnKHzENYkvVnBP6MzXtKaMVJN0HwB2ke8_EfY6yHqaN2Af9u4wo99Cx7P3OB8uMZPKzf2LV6uwAO-A6wHfPsMeDpG13U3l-hTp_sAX471Av36cb-cLrKHx_nP6e1DZgpexqxpQICudSM0A0mBSiF5JUsqOmBghCllIauq7kwt61oy2qaDmTBcSN0wKvgFujnwbsdmA62BIXnRq623G-3_KKetevsz2JV6djtFKa2SGksM344M3r2MEKLa2GCgT8eDG4NiSZWVydMqQa8PUONdCB66Vx1K1D4KtVanUah9FIpIlYxOw19PN30d_e99AswOAEh-7Sx4FYyFwUBrPZioWmffo_MXIh6hBQ</recordid><startdate>202210</startdate><enddate>202210</enddate><creator>Chen, Qiudong</creator><creator>Kobashigawa, Jon</creator><creator>Emerson, Dominic</creator><creator>Singer-Englar, Tahli</creator><creator>Megna, Dominick</creator><creator>Ramzy, Danny</creator><creator>Catarino, Pedro</creator><creator>Trento, Alfredo</creator><creator>Chikwe, Joanna</creator><creator>Kittleson, Michelle</creator><creator>Esmailian, Fardad</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-1445-6610</orcidid><orcidid>https://orcid.org/0000-0002-7328-5903</orcidid></search><sort><creationdate>202210</creationdate><title>Heart Transplantation With Older Donors: Should There Be an Age Cutoff?</title><author>Chen, Qiudong ; Kobashigawa, Jon ; Emerson, Dominic ; Singer-Englar, Tahli ; Megna, Dominick ; Ramzy, Danny ; Catarino, Pedro ; Trento, Alfredo ; Chikwe, Joanna ; Kittleson, Michelle ; Esmailian, Fardad</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c436t-bbe5ea9ab5a2e71e1757387615fe2ec5c6747889fc9799721d01625c357ab2153</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Adult</topic><topic>Age Factors</topic><topic>Heart Diseases - etiology</topic><topic>Heart Transplantation - adverse effects</topic><topic>Humans</topic><topic>Kaplan-Meier Estimate</topic><topic>Middle Aged</topic><topic>Retrospective Studies</topic><topic>Tissue Donors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Chen, Qiudong</creatorcontrib><creatorcontrib>Kobashigawa, Jon</creatorcontrib><creatorcontrib>Emerson, Dominic</creatorcontrib><creatorcontrib>Singer-Englar, Tahli</creatorcontrib><creatorcontrib>Megna, Dominick</creatorcontrib><creatorcontrib>Ramzy, Danny</creatorcontrib><creatorcontrib>Catarino, Pedro</creatorcontrib><creatorcontrib>Trento, Alfredo</creatorcontrib><creatorcontrib>Chikwe, Joanna</creatorcontrib><creatorcontrib>Kittleson, Michelle</creatorcontrib><creatorcontrib>Esmailian, Fardad</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Transplantation proceedings</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Chen, Qiudong</au><au>Kobashigawa, Jon</au><au>Emerson, Dominic</au><au>Singer-Englar, Tahli</au><au>Megna, Dominick</au><au>Ramzy, Danny</au><au>Catarino, Pedro</au><au>Trento, Alfredo</au><au>Chikwe, Joanna</au><au>Kittleson, Michelle</au><au>Esmailian, Fardad</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Heart Transplantation With Older Donors: Should There Be an Age Cutoff?</atitle><jtitle>Transplantation proceedings</jtitle><addtitle>Transplant Proc</addtitle><date>2022-10</date><risdate>2022</risdate><volume>54</volume><issue>8</issue><spage>2088</spage><epage>2096</epage><pages>2088-2096</pages><issn>0041-1345</issn><eissn>1873-2623</eissn><abstract>Heart transplantation remains limited by donor availability. 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The ≥55 years group had a significantly lower freedom from cardiac allograft vasculopathy and fatal major adverse cardiac events. In propensity-matched patients, recipients of donors ≥55 years had similar survival and freedom from cardiac allograft vasculopathy but significantly lower 1-year (76.7% vs 88.3%, P = .026), 3-year (68.3% vs 84.2%, P = .010), and 5-year (63.3% vs 83.3%, P = .002) freedom from nonfatal major adverse cardiac events when compared to recipients of younger donors. Carefully selected older donors can be considered for a carefully selected group of recipients with acceptable outcomes.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>36192208</pmid><doi>10.1016/j.transproceed.2022.07.004</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-1445-6610</orcidid><orcidid>https://orcid.org/0000-0002-7328-5903</orcidid></addata></record>
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source ScienceDirect Freedom Collection
subjects Adult
Age Factors
Heart Diseases - etiology
Heart Transplantation - adverse effects
Humans
Kaplan-Meier Estimate
Middle Aged
Retrospective Studies
Tissue Donors
title Heart Transplantation With Older Donors: Should There Be an Age Cutoff?
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