Heart transplantation using allografts from older donors: Multicenter study results

Autores de IIS La Fe

• Luis Almenar Bonet

  Autor

• Francisco Miranda Segovia

  Autor

• Vicente Mirabet Lis

  Autor

Participantes ajenos a IIS La Fe

• Roig E
• Crespo-Leiro M
• Delgado J
• Pérez-Villa F
• Luís Lambert J
• Teresa Blasco M
• Muñiz J
• rest of the participants of the Spanish Heart Transplantation Registry

Grupos

• Grupo de Investigación Clínica y Traslacional en Cardiología

• Regeneración y Trasplante Cardíaco

Abstract

BACKGROUND: The lengthy waiting time for heart transplantation is associated with high mortality. To increase the number of donors, new strategies have emerged, including the use of hearts from donors >= 50 years old. However, this practice remains controversial. The aim of this study was to evaluate outcomes of patients receiving heart transplants from older donors. METHODS: We retrospectively analyzed 2,102 consecutive heart transplants in 8 Spanish hospitals from 1998 to 2010. Acute and overall mortality were compared in patients with grafts from donors >= 50 years old versus grafts from younger donors. RESULTS: There were 1,758 (84%) transplanted grafts from donors < 50 years old (Group I) and 344 (16%) from donors >= 50 years old (Group II). Group I had more male donors than Group 11 (71% vs 57%, p = 0.0001). The incidence of cardiovascular risk factors was higher in older donors. There were no differences in acute mortality or acute rejection episodes between the 2 groups. Global mortality was higher in Group If (rate ratio, 1.40; 95% confidence interval, 1.18-1.67; p = 0.001) than in Group I. After adjusting for donor cause of death, donor smoking history, recipient age, induction therapy, and cyclosporine therapy, the differences lost significance. Group II had a higher incidence of coronary allograft vasculopathy at 5 years (rate ratio, 1.67; 95% confidence interval, 1.22-2.27; p = 0.001). CONCLUSIONS: There were no differences in acute and overall mortality after adjusting for confounding factors. However, there was a midterm increased risk of coronary allograft vasculopathy with the use of older donors. Careful selection of recipients and close monitoring of coronary allograft vasculopathy are warranted in these patients. J Heart Lung Transplant 2015;34:790-796 (C) 2015 International Society for Heart and Lung Transplantation. All rights reserved.

Keywords

• heart transplantation; older donors; cardiac allograft vasculopathy; HTx prognosis; survival after HTx