A Higher Need for Permanent Pacing after Orthotopic Heart Transplantation Due to Increased Donor Age

• Published in: The Journal of heart and lung transplantation Vol. 38; no. 4; p. S401
• Main Authors: Roest, S., Akca, F., Kolff, M.A., Veenis, J.F., Constantinescu, A.A., Brugts, J.J., Birim, O., Manintveld, O.C., Szili-Torok, T., Caliskan, K.
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01-04-2019
• ISSN: 1053-2498; 1557-3117
• DOI: 10.1016/j.healun.2019.01.1021

Extreme shortage in donors in the Netherlands has led to increasingly aging donors in heart transplantations (HT). The aim of the study was to evaluate the relationship between donor age and the need for a permanent pacemaker (PPM) implantation after HT.
All HTs in our centre between 1984 and august 2018 were retrospectively analysed. Retransplantation within 30 days (n=2) and patients who died within 30 days after HT (n=53) were excluded from the study. In this study 664 HTs were included. Based on the donor age, the HTs were divided into three groups: Group I (<35 years, n=361), Group II (35-50 years, n=207) and Group III (>50 years, n=96). Primary outcome was the implantation of a PPM post-HT, either early (≤ 90 days) or late (> 90 days).
The biatrial technique was performed in 659 HTs and only 5 using the bicaval technique. Before 2000 (the moment of immunosuppressive regime switch from cyclosporine- to tacrolimus-based therapy), the median donor age was 26 [IQR 20-35] and after 2000 42 [IQR 25-51] (P < 0.001). The median follow-up was 9 years [IQR 4-14]. In total, 96 (14.5%) PPM were implanted post-HT; 43 (45%) ≤ 90 days (median 37 days [IQR 29-42]) and in 53 (55%) > 90 days (median 7.6 years [IQR 3.4-13.4]) post-HT. The early PPM rate was 1.5% before 2000 vs 11% late PPM rate, while after 2000 the rates were 10.6% and 5.9% respectively. Indications for PPM implantation were sinus node dysfunction in 52.1% and atrioventricular block in 47.9%. Total PPM rates were 10% (Group I), 18% (Group II) and 25% (Group III) (P<0.001). Early PPM rates were higher in Group III compared to Group I (15% vs 2%, respectively, P=0.001). Late PPM rates were not statistically different (10% vs 8%, respectively, P=0.46). Mean ischemic times were not statistically different between Group I, II and III (178 ± 47, 181 ± 46 and 184 ± 46, respectively, P=0.37). Survival in patients with a PPM was significantly better than in patients without PPM (median of 16.9 years [IQR 14.5-19.2] and 12.9 years [IQR 11.8-13.9] respectively, P=0.027).
The need for an early PPM is statistically higher in HTs with a donor age > 50 years. However, the long-term survival was non-inferior in patients with a PPM.