CLINICAL RESEARCH: CARDIAC TRANSPLANT AND ASSIST DEVICES
Outcomes in cardiac transplant recipients using allografts from older donors versus mortality on the transplant waiting list
Implications for donor selection criteria
Katherine Lietz, MD, PhD*,
Ranjit John, MD*,*,
Donna M. Mancini, MD and
Niloo M. Edwards, MD*
* Cardiothoracic Surgery, New York, New YorkUSA
Cardiology, Columbia Presbyterian Medical Center, Columbia University, New York, New York, USA
Manuscript received June 6, 2003;
revised manuscript received August 9, 2003,
accepted August 18, 2003.
* Reprint requests and correspondence: Dr. Ranjit John, Division of Cardiothoracic Surgery, Columbia Presbyterian Medical Center, Milstein Hospital Building 7-435, 177 Fort Washington Avenue, New York, New York 10032, USA.
ranjitj{at}pol.net
OBJECTIVES: This study investigates the outcomes of cardiac transplantation using older donors.
BACKGROUND: Despite high mortality rates on waiting lists, transplanting hearts from older donors remains a relative contraindication.
METHODS: We retrospectively reviewed data on 479 adult heart transplant recipients, 352 status I patients, and 534 status II patients enrolled on a waiting list between 1992 and 1999. The Cox proportional hazards model was used for statistical analysis.
RESULTS: Of all donors, 20% were 40 to 50 years old and 8% were  50 years old. The risk of six-month mortality on the waiting list for patients who were not transplanted (status I: relative risk [RR] 8.5; status II: RR 3.7) significantly outweighed the risk of transplanting patients with a heart from donors >40 years old (status I: RR 1.6; status II: RR 2.1). Recipients of cardiac allografts from donors <40 years old had a one-month mortality rate of 5%, in contrast to 13% and 22% in those receiving allografts from donors 40 to 50 years old and 50 years old, respectively. Donor age did not influence long-term survival or frequency of rejections; however, it did correlate with the early presence of transplant-related coronary artery disease (TCAD). By the first annual angiogram, only 17% of recipients with donors <20 years old developed TCAD, in contrast to 26% to 30% and 34% of recipients who received allografts from donors age 20 to 40 years and >40 years, respectively.
CONCLUSIONS: Despite a strong association between older donor age and increased post-operative mortality and TCAD, it is more beneficial in terms of patient survival to receive an allograft from a donor >40 years old than to remain on the waiting list.
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Abbreviations and Acronyms
| | CAD | = coronary artery disease | | CI | = confidence interval | | CVA | = cerebrovascular accident | | HLA | = human leukocyte antigen | | LVAD | = left ventricular assist device | | RR | = relative risk | | TCAD | = transplant-related coronary artery disease | | UNOS | = United Network of Organ Sharing |
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