Heart Transplantation with Older Donors: Should There Be an Age Cutoff

Abstract

Heart transplantation (HTx) remains limited by donor availability. Although the traditional cutoff age for heart transplant donors is 55 years, only a few programs accept older donors (≥55 yrs) in an effort to broaden the donor pool. The ISHLT registry has reported that older donor age is a risk factor for recipient mortality following HTx. The use of these older donor hearts remains contentious. We assessed our HTx recipients who received donors ≥55 years and compared them to those who received donors <55 years old. Between 2010 and 2018, we assessed 815 HTx recipients and divided them into those who received donors ≥ 55 years (n=65) and those who received donors <55 years (n=750). Endpoints included 1, 3 and 5 year survival, 1-year freedom from cardiac allograft vasculopathy (CAV) as defined by stenosis ≥30% by angiography, 1-year freedom from non-fatal major adverse cardiac events (NF-MACE: myocardial infarction, new congestive heart failure, percutaneous coronary intervention, implantable cardioverter defibrillator/pacemaker implant, stroke), and 1-year freedom from any-treated rejection, acute cellular rejection and antibody-mediated rejection. There was no significant difference between the two groups in terms of 1, 3 and 5 year survival. The donor ≥55 group also had a significantly lower freedom from CAV and NF-MACE at 1 year. There was no difference in any type of rejection between the two groups. Heart transplant recipients receiving donor hearts ≥55 years appear to have acceptable early and mid-term survival. Despite the lower freedom from CAV, the older donors can be considered for a selected group of recipients with acceptable outcome. Larger numbers are warranted to confirm these findings.