Heart transplantation with super-aged donors older than 65 years

Abstract

PurposeThis study elucidated the clinical outcomes and serial allograft function of heart transplant (HTx) recipients who received hearts from super-aged donors ≥65 years of age. MethodsAdult HTx recipients between 1999 and 2022 were retrospectively reviewed and divided into two: donor age ≥65 years [super-aged donor, SAD group (n=12)] and donor age <65 years [younger donor, YD group (n=140)]. The primary endpoint was 3-year all-cause deaths after HTx. Secondary endpoints included all-cause death, hospitalization due to heart failure, acute cellular rejection, coronary intervention, and electronic device implantation. Serial cardiac function was assessed using echocardiography and right heart catheterization. ResultsCompared with the recipients in the YD group, those in the SAD group were older [age, 60 (interquartile range (IQR): 46–63) vs. 42 (IQR: 31–52) years, p<0.001], had a higher E/e’ and lower cardiac index (CI) 1 month after HTx [E/e’, 12.5 (IQR; 9.0–16.8) vs 9.5 (IQR: 7.5–11.9), p=0.026; CI, 2.8 (IQR: 2.4–3.2) L/min/m² vs. 3.3 (IQR: 2.9–3.9) L/min/m², p=0.014], and a comparable CI with higher E/e’ 1 year after HTx [E/e’, 12.0 (IQR: 8.6–13.3) vs. 7.9 (IQR: 6.6–10.6), p=0.007; CI, 3.6 (IQR: 3.2–4.3) L/min/m² vs. 3.6 (IQR: 3.3–4.2) L/min/m², p=0.99]. The 3-year overall survival was lower in the SAD group than in the YD group (81.5% vs. 97.8%, p=0.006), whereas the secondary endpoints were comparable. ConclusionSuper-aged donor hearts at ≥65 years can be used for HTx with acceptable outcomes and feasible allograft function in relatively older recipients.