Recipient Age, Not Donor Age, Impacts on Long Term Outcomes Following Heart Transplantation: A 23-year National Analysis from the United Kingdom

Abstract

The impact of donor and recipient age on outcomes following heart transplantation remains controversial. The aim of this study was to evaluate the impact of donor and recipient age on survival following heart transplantation in the United Kingdom. All heart transplants in recipients over 18, performed at the six transplant centres in the UK between 01/01/1995 and 31/12/2018 were included. Data were obtained from the National Health Service: Blood and Transplant database. Recipients were divided into the following groups for analysis: 18-30, 31-40, 41-50, 51-60, 61+ years, and donors: 18-30, 31-40, 41-50, 51-55, 56+ years. 3161 patients were included in this study. The overall median recipient age was 50, which has remained constant over the study period, but the proportions of transplants in the 61+ and <41 groups have increased over time. The median donor age was 38, with a trend towards more donors >50 years being used over time, although the proportion of donors <40 has increased recently with utilisation of donors after circulatory death. Kaplan Meier survival analysis demonstrated a significant decrease in long-term survival with increasing recipient age post-transplantation that was retained with 90-day conditional survival (Table 1). Whilst donor age was also correlated with reduced recipient survival, with 90-day conditional survival, there was no such association (Table 1). The impact of donor age on unconditional survival was particularly significant for recipients <40 years (p=0.002). However, with 90-day conditional survival there was no such association between outcome and donor age even in this young cohort. In this national dataset, we demonstrate that with 90-day conditional survival, donor age has no impact on long-term outcomes following heart transplantation. However, longer term survival appears more dependent on recipient age. These data support the utilisation of hearts from older donors.