Long-Term Survival after Heart Transplantation: Interaction between Donor and Recipient Age

Abstract

Purpose Increasing recipient (RA) and donor age (DA) are independently associated with mortality after Heart Transplantation (HT). The aim of this study was to analyse the impact of age-matching on HT survival. Methods 485 recipients who underwent HT between 1990 and 2018 in our Institution were divided into 4 groups: RA 50 (Group 2), RA>60-DA 60-DA>50 (Group 4), and their outcomes were compared. Emergency HT, bridge with MCS and re-HT were excluded. Mean follow-up was 109 ± 84 months. Results Preoperative data reported in Table 1. 30-day mortality across the groups was 4.9%, 9.8%, 8.1%, 9.2% from Group 1 to 4 (p=0,4). The survival of Group 1 was significantly higher than that of other groups (p=0,001), figure 1. The outcome of young recipients receiving older donor grafts did not significantly differ from that of older recipients. At multivariate analysis , donor age (HR 1,02; 95%CI:1,007-1,04) and recipient age (HR 1,05;95%CI:1,02-1,09) correlated with long-term mortality. Conclusion In this study, the use of hearts from older donors did not affect survival of older recipients; conversely, in young recipients it increased the risk of mortality. Older donor organs employment is advisable to expand the donor pool, but donor-recipient age matching should be taken into account to improve long-term outcomes.