Heart transplantation with super-aged donors older than 65 years

• Published in: JHLT Open Vol. 4; p. 100083
• Main Authors: Hada, Tasuku, Seguchi, Osamu, Kitahata, Nana, Komeyama, Shotaro, Mochizuki, Hiroki, Watanabe, Takuya, Kainuma, Satoshi, Fukushima, Satsuki, Tsukamoto, Yasumasa, Fujita, Tomoyuki, Kobashigawa, Jon, Fukushima, Norihide
• Format: Journal Article
• Language: English
• Published: Elsevier 01-05-2024
• Subjects: aged donor; cardiac function; donor evaluation; donor selection; heart transplantation
• ISSN: 2950-1334; 2950-1334
• DOI: 10.1016/j.jhlto.2024.100083

Background: This study elucidated the clinical outcomes and serial allograft function of heart transplant (HTx) recipients who received hearts from super-aged donors (SAD) ≥65 years of age. Methods: Adult HTx recipients between 1999 and 2022 were retrospectively reviewed and divided into 2: donor age ≥65 years [SAD group (n = 12)] and donor age <65 years [younger donor, YD group (n = 140)]. The primary end-point was 3-year all-cause deaths after HTx. Secondary end-points included all-cause death, hospitalization due to heart failure, acute cellular rejection, coronary intervention, and electronic device implantation. Serial cardiac function was assessed using echocardiography and right heart catheterization. Results: Compared with the recipients in the YD group, those in the SAD group were older [age, 60 (interquartile range (IQR): 46-63) vs 42 (IQR: 31-52) years, p < 0.001], had a higher E/e’ and lower cardiac index (CI) 1 month after HTx [E/e’, 12.5 (IQR: 9.0-16.8) vs 9.5 (IQR: 7.5-11.9), p = 0.026; CI, 2.8 (IQR: 2.4-3.2) liter/min/m² vs 3.3 (IQR: 2.9-3.9) liter/min/m², p = 0.014], and a comparable CI with higher E/e’ 1 year after HTx [E/e’, 12.0 (IQR: 8.6-13.3) vs 7.9 (IQR: 6.6-10.6), p = 0.007; CI, 3.6 (IQR: 3.2-4.3) liter/min/m² vs 3.6 (IQR: 3.3-4.2) liter/min/m², p = 0.99]. The 3-year overall survival was lower in the SAD group than in the YD group (81.5% vs 97.8%, p = 0.006), whereas the secondary end-points were comparable. Conclusion: SAG hearts at ≥65 years can be used for HTx with acceptable outcomes and feasible allograft function in relatively older recipients.