The Continuous Debate of Older Donors into Older Recipients: Another Angle
Cedars Sinai Medical Center, Los Angeles.
Meeting: 2018 American Transplant Congress
Abstract number: B32
Keywords: Age factors, Donors, Heart/lung transplantation, unrelated
Session Information
Date: Sunday, June 3, 2018
Session Name: Poster Session B: Heart and VADs: All Topics
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall 4EF
Purpose: Heart transplantation (HTx) remains limited by donor availability. Many programs accept older donors (≥50 yrs) for older recipients (≥ 60 yrs) in an effort to broaden the donor pool. However, the ISHLT registry has reported that older donor age is a risk factor for recipient mortality following HTx. The outcomes from older donor hearts following HTx remains contentious. We evaluated outcomes of our older recipient population who received older donor hearts and compared them to older recipients who received younger donor hearts.
Methods: Between 2007-14, we reviewed 710 HTx patients (pts). We identified 313 pts age ≥60 years at the time of HTx and stratified them into 2 groups: Donor age <50yrs (n=233) and ≥50yrs (n=80). At time of HTx, status 1A/1B was 64.8% for donor age <50yrs and 53.8% for donor age ≥50yrs. We assessed both groups for 3-year actuarial survival, freedom from cardiac allograft vasculopathy (CAV, stenosis ≥30%), and freedom from non-fatal major adverse cardiac events (NF-MACE: MI, CHF, stroke, and need for angioplasty or pacemaker/ICD). 1-year freedom from any-treated rejection was assessed.
Results: Mean recipient age was significantly higher for older vs younger donors. Recipients with donors ≥50yrs vs <50yrs had significantly lower 3-year survival (74.8% vs 91.2%, p < 0.001) and 3-year freedom from CAV (73.5% vs 82.2%, p = 0.036). There was a statistical trend for a lower 3-year freedom from NF-MACE (84.0% vs 91.5%, p = 0.051). 1-year freedom from any-treated rejection was similar between groups.
Conclusion: Older recipients (≥ 60 yrs) receiving older donor hearts (≥ 50 yrs) appear to have sub-optimal outcomes following HTx. However, the use of older donor hearts for older recipients allows older recipients to have reasonable survival with donor hearts that would normally be discarded. This survival is far better than without transplant considering that majority of these pts are urgent status.
| Recipient Age ≥ 60 | Donor Age < 50 (n=233) | Donor Age ≥ 50 | P-Value |
| Mean Donor Age ± SD | 31.1 ± 10.1 | 54.6 ± 3.9 | <0.001 |
| Mean Recipient Age ± SD | 66.3 ± 3.9 | 67.4 ± 3.9 | 0.030 |
| 3-Yr Survival | 91.2% | 74.8% | <0.0001 |
| 3-Yr Freedom from CAV | 82.2% | 73.5% | 0.036 |
| 3-Yr Freedom from NF-MACE | 91.5% | 84.0% | 0.051 |
| 1-Yr Freedom from Any-Treated Rejection | 86.2% | 83.0% | 0.489 |
CITATION INFORMATION: Patel J., Kittleson M., Kransdorf E., Dimbil S., Levine R., Geft D., Chang D., Czer L., Kobashigawa J. The Continuous Debate of Older Donors into Older Recipients: Another Angle Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Patel J, Kittleson M, Kransdorf E, Dimbil S, Levine R, Geft D, Chang D, Czer L, Kobashigawa J. The Continuous Debate of Older Donors into Older Recipients: Another Angle [abstract]. https://atcmeetingabstracts.com/abstract/the-continuous-debate-of-older-donors-into-older-recipients-another-angle/. Accessed March 23, 2019.« Back to 2018 American Transplant Congress