Heart Transplant Recipient and Donor Age: Should the Younger Recipient Be Matched with the Younger Donor?

Abstract

Purpose With the shortage of donor hearts, older donors are being increasingly evaluated for potential recipients. Currently it is unknown if the younger recipients is affected by donor age. We sought to evaluate the outcomes in younger heart transplant recipients from younger and older donors and conversely, the older heart transplant recipients from younger and older donors. Methods We analyzed The United Network for Organ Sharing data registry for all adult heart transplant recipients (HTR) from 2008 to 2017. HTR with right or bi-ventricular support or TAH were excluded. Patients were stratified based on recipient age (R) 18-29, 20-39, 40-49 and >50 years old and donor age (D) 18-29, 20-39, 40-49 and >50 years old. Kaplan-Meier estimates were used to evaluate overall survival. Potential confounders were adjusted for, using a Cox proportional hazards model. Results 19,514 HTR were included in the analysis. In the overall cohort of HTR, 6.22% (n=1213) were 18-29, 8.48% (n=28670 were 30-39, 15.42% (n=5877), and 69.88%were >50 years old. In the DN category 45.10% (n=8801) were 18-29, 25.90% (n=5054) were 30-39, 19.59% (n=3822) were 40-49 and 9.41% (n=1837) were >50 years old. Adjusting for other variables, the age of donor was not associated with decreased survival in R18-39. R40-49 receiving a HTX from D40-49 and D>50 had a 43% and 75 % decreased survival at 10 years, when compared to receiving from D 18-29. Similarly, R>50 receiving a HTX from D30-39, D40-49, D>50 had a 14%, 27%, and 47% decreased survival at 10 years. Cox proportional regression analysis also indicates that African American recipients, female donor to male recipient, higher BMI and previous LVAD support decrease survival. Conclusion In a population based analysis, donor age does not appear to impact survival in younger recipients. Recipient related factors (including other co-morbidities) might potentially contribute to decreased survival in older recipients. This information can be potentially used to expand the donor organ pool. With the shortage of donor hearts, older donors are being increasingly evaluated for potential recipients. Currently it is unknown if the younger recipients is affected by donor age. We sought to evaluate the outcomes in younger heart transplant recipients from younger and older donors and conversely, the older heart transplant recipients from younger and older donors. We analyzed The United Network for Organ Sharing data registry for all adult heart transplant recipients (HTR) from 2008 to 2017. HTR with right or bi-ventricular support or TAH were excluded. Patients were stratified based on recipient age (R) 18-29, 20-39, 40-49 and >50 years old and donor age (D) 18-29, 20-39, 40-49 and >50 years old. Kaplan-Meier estimates were used to evaluate overall survival. Potential confounders were adjusted for, using a Cox proportional hazards model. 19,514 HTR were included in the analysis. In the overall cohort of HTR, 6.22% (n=1213) were 18-29, 8.48% (n=28670 were 30-39, 15.42% (n=5877), and 69.88%were >50 years old. In the DN category 45.10% (n=8801) were 18-29, 25.90% (n=5054) were 30-39, 19.59% (n=3822) were 40-49 and 9.41% (n=1837) were >50 years old. Adjusting for other variables, the age of donor was not associated with decreased survival in R18-39. R40-49 receiving a HTX from D40-49 and D>50 had a 43% and 75 % decreased survival at 10 years, when compared to receiving from D 18-29. Similarly, R>50 receiving a HTX from D30-39, D40-49, D>50 had a 14%, 27%, and 47% decreased survival at 10 years. Cox proportional regression analysis also indicates that African American recipients, female donor to male recipient, higher BMI and previous LVAD support decrease survival. In a population based analysis, donor age does not appear to impact survival in younger recipients. Recipient related factors (including other co-morbidities) might potentially contribute to decreased survival in older recipients. This information can be potentially used to expand the donor organ pool.