Impact of donor-recipient age on cardiac transplant survival. Subanalysis of the Spanish Heart Transplant Registry

López‐Vilella, Raquel; González‐Vílchez, Francisco; Crespo‐Leiro, María G.; Segovia‐Cubero, Javier; Cobo, Manuel; Delgado-Jiménez, Juan; Prado, José María Arizón del; Martínez‐Sellés, Manuel; Marquez, José; Mirabet‐Pérez, Sónia; González-Costello, José; Pérez‐Villa, Félix; Lambert-Rodríguez, José Luis; Rábago-Aracil, Gregorio; Blasco-Peiró, María Teresa; Fuente-Galán, Luis de la; Garrido-Bravo, Iris P.; Otero, Déborah; Almenar‐Bonet, Luis

doi:10.1016/j.rec.2020.02.016

Cited by 5 publications

(4 citation statements)

References 28 publications

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“…It was no surprise that patients of the D Y /R Y group had the best outcome as this has been reported in several previous studies [14][15][16][17] Nevertheless, the implications of these results represent some kind of ethical dilemma. First, young donors should be allocated to every recipient, as this was best for all recipient ages.…”

Section: Discussionsupporting

confidence: 53%

Heart Transplantation of the Elderly—Old Donors for Old Recipients: Can We Still Achieve Acceptable Results?

Immohr

Aubin

Westenfeld

et al. 2022

JCM

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As society is ageing, an increasing prevalence of elderly heart failure patients will be expected. In order to increase the donor pool, acceptance of older donors might be a reasonable choice. All patients undergoing heart transplantation between 2010 and 2021 at a single department were retrospectively reviewed and divided into different study groups with regard to recipient (≤60 years (RY) or >60 years (RO)) and donor age (≤50 years (DY) or >50 years (DO). A total of n = 201 patients were included (DY/RY, n = 91; DO/RY, n = 38; DY/RO, n = 41; DO/RO, n = 31). Neither incidence of severe primary graft dysfunction (p = 0.64) nor adverse events, such as kidney failure (p = 0.27), neurological complications (p = 0.63), infections (p = 0.21) or acute graft rejection (p = 1.00), differed between the groups. However, one-year survival was impaired in the DO/RO group (56.0%) compared to the other groups (DY/RY: 86.1%, DY/RO: 78.8%, DO/RY: 74.2%, p = 0.02). Given the impaired one-year survival, acceptance of grafts from old donors for old recipients should be performed with caution and by experienced centres only. Nevertheless, because of the otherwise dismal prognosis of elderly heart failure patients, transplantation of patients may still improve the therapy outcome.

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Section: Discussionsupporting

confidence: 53%

Heart Transplantation of the Elderly—Old Donors for Old Recipients: Can We Still Achieve Acceptable Results?

Immohr

Aubin

Westenfeld

et al. 2022

JCM

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“…Apart from older donor age, various factors influence patient survival post-HTx. A study using data from the Spanish Heart Transplant Registry identified recipient age as a significant factor contributing to overall HTx patient survival 24 . Older recipient age is associated with multiple comorbidities and poor overall survival, necessitating careful patient selection 23 .…”

Section: Discussionmentioning

confidence: 99%

Examining a 12-year experience within Kazakhstan’s national heart transplantation program

Semenova,

Shaisultanova,

Beyembetova

et al. 2024

Sci Rep

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Kazakhstan has one of the lowest heart transplantation (HTx) rates globally, but there are no studies evaluating the outcomes of HTx. This study aimed to provide a comprehensive analysis of the national HTx program over a 12-year period (2012–2023). Survival analysis of the national HTx cohort was conducted using life tables, Kaplan‒Meier curves, and Cox regression methods. Time series analysis was applied to analyze historical trends in HTx per million population (pmp) and to make future projections until 2030. The number of patients awaiting HTx in Kazakhstan was evaluated with a regional breakdown. The pmp rates of HTx ranged from 0.06 to 1.08, with no discernible increasing trend. Survival analysis revealed a rapid decrease in the first year after HTx, reaching 77.0% at 379 days, with an overall survival rate of 58.1% at the end of the follow-up period. Among the various factors analyzed, recipient blood levels of creatinine and total bilirubin before surgery, as well as the presence of infection or sepsis and the use of ECMO after surgery, were found to be significant contributors to the survival of HTx patients. There is a need for public health action to improve the HTx programme.

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“…Nowadays, cardiac transplant (CT) recipients tend to be older, and have more comorbidities, and they often need anticoagulation or antiplatelet therapy [1]. In parallel, the therapeutic arsenal has expanded with the introduction of direct‐acting oral anticoagulants (DOAC), including FXa inhibitors, such as rivaroxaban, apixaban, and edoxaban, and the direct thrombin inhibitor (dabigatran), as well as newly developed antiplatelet drugs like ticagrelor and prasugrel.…”

Section: Introductionmentioning

confidence: 99%

Anticoagulation and Antiplatelet Regimen in Cardiac Transplant. Clinical Characteristics, Outcomes, and Blood Product Transfusion

Groba Marco,

Saavedra Santana,

Gonzalez del Castillo

et al. 2024

Clinical Transplantation

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BackgroundWe aimed to evaluate the characteristics, clinical outcomes, and blood product transfusion (BPT) rates of patients undergoing cardiac transplant (CT) while receiving uninterrupted anticoagulation and antiplatelet therapy.MethodsA retrospective, single‐center, and observational study of adult patients who underwent CT was performed. Patients were classified into four groups: (1) patients without anticoagulation or antiplatelet therapy (control), (2) patients on antiplatelet therapy (AP), (3) patients on vitamin K antagonists (AVKs), and (4) patients on dabigatran (dabigatran). The primary endpoints were reoperation due to bleeding and perioperative BPT rates (packed red blood cells (PRBC), fresh frozen plasma, platelets). Secondary outcomes assessed included morbidity and mortality‐related events.ResultsOf the 55 patients included, 6 (11%) received no therapy (control), 8 (15%) received antiplatelet therapy, 15 (27%) were on AVKs, and 26 (47%) were on dabigatran. There were no significant differences in the need for reoperation or other secondary morbidity‐associated events. During surgery patients on dabigatran showed lower transfusion rates of PRBC (control 100%, AP 100%, AVKs 73%, dabigatran 50%, p = 0.011) and platelets (control 100%, AP 100%, AVKs 100%, dabigatran 69%, p = 0.019). The total intraoperative number of BPT was also the lowest in the dabigatran group (control 5.5 units, AP 5 units, AVKs 6 units, dabigatran 3 units; p = 0.038); receiving significantly less PRBC (control 2.5 units, AP 3 units, AVKs 2 units, dabigatran 0.5 units; p = 0.011). A Poisson multivariate analysis showed that only treatment on dabigatran reduces PRBC requirements during surgery, with an expected reduction of 64.5% (95% CI: 32.4%–81.4%).ConclusionsIn patients listed for CT requiring anticoagulation due to nonvalvular atrial fibrillation, the use of dabigatran and its reversal with idarucizumab significantly reduces intraoperative BPT demand.

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Impact of donor-recipient age on cardiac transplant survival. Subanalysis of the Spanish Heart Transplant Registry

Abstract: Impact of donor-recipient age on cardiac transplant survival.

Cited by 5 publications

References 28 publications

Heart Transplantation of the Elderly—Old Donors for Old Recipients: Can We Still Achieve Acceptable Results?

Heart Transplantation of the Elderly—Old Donors for Old Recipients: Can We Still Achieve Acceptable Results?

Examining a 12-year experience within Kazakhstan’s national heart transplantation program

Anticoagulation and Antiplatelet Regimen in Cardiac Transplant. Clinical Characteristics, Outcomes, and Blood Product Transfusion

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