Raquel López-Vilella1, Francisco González-Vílchez2, María G Crespo-Leiro3, Javier Segovia-Cubero4, Manuel Cobo2, Juan Delgado-Jiménez5, José María Arizón Del Prado6, Manuel Martínez-Sellés7, José Manuel Sobrino Márquez8, Sonia Mirabet-Pérez9, José González-Costello10, Félix Pérez-Villa11, José Luis Lambert-Rodríguez12, Gregorio Rábago-Aracil13, María Teresa Blasco-Peiró14, Luis de la Fuente-Galán15, Iris Garrido-Bravo16, Déborah Otero17, Luis Almenar-Bonet18. 1. Unidad de Insuficiencia Cardiaca y Trasplante, Servicio de Cardiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain. Electronic address: lopez_raqvil@gva.es. 2. Servicio de Cardiología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain. 3. Servicio de Cardiología, Complexo Hospitalario Universitario A Coruña (CHUAC), A Coruña, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, CIBERCV, A Coruña, Spain; Instituto de Investigación Biomédico A Coruña (INIBIC), A Coruña, Spain; Universidade da Coruña (UDC), A Coruña, Spain. 4. Servicio de Cardiología, Hospital Universitario Puerta de Hierro de Majadahonda, Majadahonda, Madrid, Spain. 5. Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, CIBERCV, Madrid, Spain. 6. Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain. 7. Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, CIBERCV, Madrid, Spain; Servicio de Cardiología, Hospital Universitario Gregorio Marañón, Madrid, Spain; Universidad Europea de Madrid, Madrid, Spain. 8. Servicio de Cardiología, Hospital Universitario Virgen del Rocío, Sevilla, Spain. 9. Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. 10. Servicio de Cardiología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain. 11. Servicio de Cardiología, Hospital Clínic y Provincial de Barcelona, Barcelona, Spain. 12. Servicio de Cardiología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain. 13. Servicio de Cardiología, Clínica Universitaria de Navarra, Pamplona, Navarra, Spain. 14. Servicio de Cardiología, Hospital Universitario Miguel Servet, Zaragoza, Spain. 15. Servicio de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain. 16. Servicio de Cardiología, Hospital Virgen de la Arrixaca, El Palmar, Murcia, Spain. 17. Instituto de Investigación Biomédico A Coruña (INIBIC), A Coruña, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, CIBERCV, A Coruña, Spain; Universidade da Coruña (UDC), A Coruña, Spain; Instituto Universitario de Ciencias de la Salud, A Coruña, Spain. 18. Unidad de Insuficiencia Cardiaca y Trasplante, Servicio de Cardiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, CIBERCV, Madrid, Spain; Facultad de Medicina, Universitat de València, Valencia, Spain.
Abstract
INTRODUCTION AND OBJECTIVES: The age of heart transplant recipients and donors is progressively increasing. It is likely that not all donor-recipient age combinations have the same impact on mortality. The objective of this work was to compare survival in transplant recipients according to donor-recipient age combinations. METHODS: We performed a retrospective analysis of transplants performed between 1 January 1993 and 31 December 2017 in the Spanish Heart Transplant Registry. Pediatric transplants, retransplants and combined transplants were excluded (6505 transplants included). Four groups were considered: a) donor <50 years for recipient <65 years; b) donor <50 years for recipient ≥ 65 years; c) donor ≥ 50 years for recipient ≥ 65 years, and d) donor ≥ 50 years for recipient <65 years. RESULTS: The most frequent group was young donor for young recipient (73%). There were differences in the median survival between the groups (P <.001): a) younger-younger: 12.1 years, 95%CI, 11.5-12.6; b) younger-older: 9.1 years, 95%CI, 8.0-10.5; c) older-older: 7.5 years, 95%CI, 2.8-11.0; d) older-younger: 10.5 years, 95%CI, 9.6-12.1. On multivariate analysis, independent predictors of mortality were the age of the donor and the recipient (0.008 and 0.001, respectively). The worst combinations were older-older vs younger-younger (HR, 1.57; 95%CI, 1.22-2.01; P <.001) and younger-older vs younger-younger (HR, 1.33; 95%CI, 1.12-1.58; P=.001). CONCLUSIONS: Age (of the donor and recipient) is a relevant prognostic factor in heart transplant. The donor-recipient age combination has prognostic implications that should be identified when accepting an organ for transplant.
INTRODUCTION AND OBJECTIVES: The age of heart transplant recipients and donors is progressively increasing. It is likely that not all donor-recipient age combinations have the same impact on mortality. The objective of this work was to compare survival in transplant recipients according to donor-recipient age combinations. METHODS: We performed a retrospective analysis of transplants performed between 1 January 1993 and 31 December 2017 in the Spanish Heart Transplant Registry. Pediatric transplants, retransplants and combined transplants were excluded (6505 transplants included). Four groups were considered: a) donor <50 years for recipient <65 years; b) donor <50 years for recipient ≥ 65 years; c) donor ≥ 50 years for recipient ≥ 65 years, and d) donor ≥ 50 years for recipient <65 years. RESULTS: The most frequent group was young donor for young recipient (73%). There were differences in the median survival between the groups (P <.001): a) younger-younger: 12.1 years, 95%CI, 11.5-12.6; b) younger-older: 9.1 years, 95%CI, 8.0-10.5; c) older-older: 7.5 years, 95%CI, 2.8-11.0; d) older-younger: 10.5 years, 95%CI, 9.6-12.1. On multivariate analysis, independent predictors of mortality were the age of the donor and the recipient (0.008 and 0.001, respectively). The worst combinations were older-older vs younger-younger (HR, 1.57; 95%CI, 1.22-2.01; P <.001) and younger-older vs younger-younger (HR, 1.33; 95%CI, 1.12-1.58; P=.001). CONCLUSIONS: Age (of the donor and recipient) is a relevant prognostic factor in heart transplant. The donor-recipient age combination has prognostic implications that should be identified when accepting an organ for transplant.
Keywords:
Combinaciones de edad de donante y receptor; Donor age; Donor/recipient age combinations; Edad del donante; Edad del receptor; Heart transplant; Recipient age; Supervivencia; Survival; Trasplante cardiaco