Eulàlia Roig1, Luís Almenar2, Marisa Crespo-Leiro3, Javier Segovia4, Sònia Mirabet5, Juan Delgado6, Felix Pérez-Villa7, Jose Luís Lambert8, M Teresa Blasco9, Javier Muñiz10. 1. Servicio de Cardiologia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. Electronic address: eroigm@santpau.cat. 2. Servicio de Cardiologia, Hospital Universitario y Politecnico La Fe, Valencia, Spain. 3. Servicio de Cardiologia, Hospital Universitario A Coruña, A Coruña, Spain. 4. Servicio de Cardiologia, Clinica Puerta de Hierro, Majadahonda, Madrid, Spain. 5. Servicio de Cardiologia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. 6. Servicio de Cardiologia, Hospital 12 de Octubre, Madrid, Spain. 7. Servicio de Cardiologia, Institut Clínic del Torax, Barcelona, Spain. 8. Servicio de Cardiologia, Hospital Central de Asturias, Spain. 9. Servicio de Cardiologia, Hospital Miguel Servet, Zaragoza, Spain. 10. Instituto de Ciencias de la Salud, Universidad de A Coruña, A Coruña, Spain.
Abstract
BACKGROUND: The lengthy waiting time for heart transplantation is associated with high mortality. To increase the number of donors, new strategies have emerged, including the use of hearts from donors ≥50 years old. However, this practice remains controversial. The aim of this study was to evaluate outcomes of patients receiving heart transplants from older donors. METHODS: We retrospectively analyzed 2,102 consecutive heart transplants in 8 Spanish hospitals from 1998 to 2010. Acute and overall mortality were compared in patients with grafts from donors ≥50 years old versus grafts from younger donors. RESULTS: There were 1,758 (84%) transplanted grafts from donors < 50 years old (Group I) and 344 (16%) from donors ≥50 years old (Group II). Group I had more male donors than Group II (71% vs. 57%, p = 0.0001). The incidence of cardiovascular risk factors was higher in older donors. There were no differences in acute mortality or acute rejection episodes between the 2 groups. Global mortality was higher in Group II (rate ratio, 1.40; 95% confidence interval, 1.18-1.67; p = 0.001) than in Group I. After adjusting for donor cause of death, donor smoking history, recipient age, induction therapy, and cyclosporine therapy, the differences lost significance. Group II had a higher incidence of coronary allograft vasculopathy at 5 years (rate ratio, 1.67; 95% confidence interval, 1.22-2.27; p = 0.001). CONCLUSIONS: There were no differences in acute and overall mortality after adjusting for confounding factors. However, there was a midterm increased risk of coronary allograft vasculopathy with the use of older donors. Careful selection of recipients and close monitoring of coronary allograft vasculopathy are warranted in these patients.
BACKGROUND: The lengthy waiting time for heart transplantation is associated with high mortality. To increase the number of donors, new strategies have emerged, including the use of hearts from donors ≥50 years old. However, this practice remains controversial. The aim of this study was to evaluate outcomes of patients receiving heart transplants from older donors. METHODS: We retrospectively analyzed 2,102 consecutive heart transplants in 8 Spanish hospitals from 1998 to 2010. Acute and overall mortality were compared in patients with grafts from donors ≥50 years old versus grafts from younger donors. RESULTS: There were 1,758 (84%) transplanted grafts from donors < 50 years old (Group I) and 344 (16%) from donors ≥50 years old (Group II). Group I had more male donors than Group II (71% vs. 57%, p = 0.0001). The incidence of cardiovascular risk factors was higher in older donors. There were no differences in acute mortality or acute rejection episodes between the 2 groups. Global mortality was higher in Group II (rate ratio, 1.40; 95% confidence interval, 1.18-1.67; p = 0.001) than in Group I. After adjusting for donor cause of death, donor smoking history, recipient age, induction therapy, and cyclosporine therapy, the differences lost significance. Group II had a higher incidence of coronary allograft vasculopathy at 5 years (rate ratio, 1.67; 95% confidence interval, 1.22-2.27; p = 0.001). CONCLUSIONS: There were no differences in acute and overall mortality after adjusting for confounding factors. However, there was a midterm increased risk of coronary allograft vasculopathy with the use of older donors. Careful selection of recipients and close monitoring of coronary allograft vasculopathy are warranted in these patients.
Authors: Glauco Adrieno Westphal; Valter Duro Garcia; Rafael Lisboa de Souza; Cristiano Augusto Franke; Kalinca Daberkow Vieira; Viviane Renata Zaclikevis Birckholz; Miriam Cristine Machado; Eliana Régia Barbosa de Almeida; Fernando Osni Machado; Luiz Antônio da Costa Sardinha; Raquel Wanzuita; Carlos Eduardo Soares Silvado; Gerson Costa; Vera Braatz; Milton Caldeira Filho; Rodrigo Furtado; Luana Alves Tannous; André Gustavo Neves de Albuquerque; Edson Abdala Journal: Rev Bras Ter Intensiva Date: 2016-09
Authors: Oliver K Jawitz; Vignesh Raman; Jacob Klapper; Matthew Hartwig; Chetan B Patel; Carmelo Milano Journal: Transpl Int Date: 2019-08-08 Impact factor: 3.782
Authors: G Galli; K Caliskan; A H M M Balk; R van Domburg; O Birim; J Salerno-Uriarte; O C Manintveld; A A Constantinescu Journal: Neth Heart J Date: 2016-12 Impact factor: 2.380
Authors: A Sammani; A M Wind; J H Kirkels; C Klöpping; M P Buijsrogge; F Z Ramjakhan; F W Asselbergs; N de Jonge Journal: Neth Heart J Date: 2017-09 Impact factor: 2.380
Authors: Małgorzata Sobieszczańska-Małek; Jerzy Korewicki; Krzysztof Komuda; Małgorzata Karczmarz; Sylwia Szymańska; Alicja Cicha-Mikołajczyk; Paweł Bekta; Adam Parulski; Maciej Pronicki; Wiesława Grajkowska; Grzegorz Małek; Przemysław Leszek; Maria Kaczorowska; Mariusz Kuśmierczyk; Tomasz Zieliński Journal: Ann Transplant Date: 2017-11-17 Impact factor: 1.530
Authors: Jose Carlos Dayoub; Franco Cortese; Andreja Anžič; Tjaša Grum; João Pedro de Magalhães Journal: Exp Gerontol Date: 2018-06-20 Impact factor: 4.032