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The policy of placing older donors into older recipients: is it worth the risk?
Author(s) -
Tehrani Yonah Solaiman,
Yu Zhe,
Luu Minh,
Liou Frank,
Rafiei Matthew,
Hamilton Michele,
Kobashigawa Jon A.
Publication year - 2014
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.12382
Subject(s) - medicine , gerontology
Background To expand the donor pool, older donors (≥50 yr) are frequently used in older recipients (≥60 yr). Older recipients and those receiving older donor hearts have independently displayed decreased post‐transplant survival. However, outcomes in older patients receiving older donor hearts are contentious. Methods Eight hundred and seventy‐nine heart transplant patients between 2000 and 2010 were analyzed, excluding patients with donor coronary artery disease. From 380 patients ≥60 yr, 327 patients with donors <50 yr old were compared with 53 patients with donors ≥50 yr old for: five‐yr actuarial survival, freedom from cardiac allograft vasculopathy ( CAV : stenosis ≥30%), non‐fatal major adverse cardiac events ( NF ‐ MACE : MI , CHF , stroke, need for pacemaker/ ICD ), one‐yr freedom from any treated rejection. Results The older vs. younger donor group demonstrated significantly lower five‐yr survival (57% vs. 85%, p < 0.001) and freedom from CAV (83% vs. 92%, p = 0.03). No difference was observed in five‐yr freedom from NF ‐ MACE and one‐yr freedom from any treated rejection. Multivariate analysis found donor age ≥50 to be an independent risk factor for death ( HR 1.8, CI 1.1–2.9, p = 0.008) and CAV ( HR 1.9, CI 1.2–2.9, p = 0.004). Conclusions Use of older donors (≥50 yr) in older recipients (≥60 yr) results in lower five‐yr survival and freedom from CAV . Caution is required in these cases. Larger studies are warranted to confirm findings.