(430) - Heart Transplant Recipient and Donor Age Mismatching: Should the Older Recipient Be Paired with the Older Donor?

Abstract

As heart transplant (HTX) donor organs become scarcer, older donors are increasingly evaluated. It is unknown whether older donors or recipient-to-donor age discrepancies have prohibitive long-term risk. We sought to identify effects of recipient-to-donor age differences on long-term survival in HTX recipients. The United Network for Organ Sharing data registry was analyzed for all adult HTX recipients from 1987 to 2012 stratified by recipient age >= 55 years or < 55 and donor age >= 30 years or < 30. Recipients with right or bi-ventricular support or total artificial hearts were excluded. Standard statistical methods were used. 45,005 HTX recipients were included & 28.8% (n=12953) R<55 D<30, 22.9% (n=10292) R<55 D>=30, 24.1% (n=110856) R>=55 D<30, and 24.2% (n=10901) R>=55 D>=30. The mean age of the recipient and donors are: R<55 D<30 (42.4 & 20.7), R<55 D>=30 (43.9 & 40.8), R>=55 D<30 (60.6 & 20.8), R>=55 D>=30 (61.1 & 42.5). R<55 D<30 had the best long-term survival while R>=55 D>=30 the poorest (p<0.05 for log-rank & pair-wise comparisons). Causes of death varied. In multivariate analysis, LVAD at HTX did not impact survival while female donor to male recipients, African-American recipients, pulmonary hypertension, &increasing ischemic time decreased survival. In a population based analysis, the impact of donor & recipient age combinations impacts survival independently & was not impacted by the use of mechanical circulatory support. Allocation of organs should be directed so younger recipients receive younger donor hearts so as to benefit from the long-term survival advantage.