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±80months) 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≥60years) and the donor (young-D<50, old-D≥50years) 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 ≥50years of age adversely affects survival in recipients <60years 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.