The policy of placing older donors into older recipients: is it worth the risk?

Tehrani, Yonah Solaiman; Yu, Zhe; Luu, Minh B.; Liou, Frank W.; Rafiei, M.; Hamilton, Michèle A.; Kobashigawa, Jon A.

doi:10.1111/ctr.12382

Cited by 9 publications

(9 citation statements)

References 20 publications

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“…The older donor/older recipient combination thus portends a higher risk of mortality and development of CAV . In keeping with this premise, the use of older donor hearts for critically ill status 1A candidates results in higher mortality than the use of younger donor hearts, even though post‐transplant survival is improved compared to patients who did not receive a transplant .…”

Section: Discussionmentioning

confidence: 98%

“…Subsequent studies supported increasing donor age as a predictor of mortality and suggested that the combination of older age and longer ischemic time, as well as age and gender mismatch (female to male), appears particularly detrimental to long‐term outcomes . Older donor age has also been associated with a higher incidence of cardiac allograft vasculopathy (CAV) …”

Section: Introductionmentioning

confidence: 99%

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Does donor‐recipient age difference matter in outcome of heart transplantation?

Ram

Lavee

Kogan

et al. 2019

Clinical Transplantation

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Objective: Potential interactions between donor-recipient age difference and outcomes after heart transplantation are not well known. We thus aimed to study the impact of donor-recipient age difference on heart transplantation outcomes. Methods:Between 1995 and 2017, we assessed 234 heart transplantation patients.Based on donor-recipient age difference histogram, we stratified these patients into three groups: older donors (donor-recipient difference > 0; n = 48), younger donors (donor-recipient difference 0 to −20 years; n = 82), and much younger donors (donorrecipient difference <−20 years; n = 104). Results:The baseline metabolic risk profile of the recipients was significantly higher for the much younger donor group compared with the younger and older groups, including hypertension (52% vs 33% vs 25%, P = 0.002), dyslipidemia (51% vs 51% vs 29%, P = 0.027), diabetes (30% vs 16% vs 17%, P = 0.044), and smoking history (53% vs 46% vs 29%, P = 0.024), respectively. There were no significant differences between the groups in long-term survival, cardiac allograft vasculopathy, or rejectionfree survival in unadjusted and adjusted analyses. In the much younger donor group, gender matching was associated with a lower incidence of primary graft dysfunction (37% vs 58% P = 0.05).Conclusions: Donor-recipient age difference does not significantly impact long-term heart transplantation outcomes. K E Y W O R D Sage, donor, heart transplantation, recipient

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Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Does donor‐recipient age difference matter in outcome of heart transplantation?

Ram

Lavee

Kogan

et al. 2019

Clinical Transplantation

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“…10 Older donor age has also been associated with a higher incidence of cardiac allograft vasculopathy (CAV). 11,12 Study results have indicated a possibly important interaction between CIT and donor age: CITs <3.5 hr were associated with superior survival rates, and hearts from younger donors better tolerated longer CITs. 13 Approaches to improve outcomes in recipients of older allografts are poorly defined and perhaps could include more specific criteria in regard to projected CITs.…”

mentioning

confidence: 99%

Effects of Older Donor Age and Cold Ischemic Time on Long-Term Outcomes of Heart Transplantation

Reich¹,

Kobashigawa²,

Aintablian³

et al. 2018

Texas Heart Institute Journal

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Using older donor hearts in cardiac transplantation may lead to inferior outcomes: older donors have more comorbidities that reduce graft quality, including coronary artery disease, hypertension, diabetes mellitus, and dyslipidemia. Shorter cold ischemic times might overcome the detrimental effect of older donor age. We examined the relationship between donor allograft age and cold ischemic time on the long-term outcomes of heart transplant recipients. rom 1994 through 2010, surgeons at our hospital performed 745 heart transplantations. We retrospectively classified these cases by donor ages of <50 years (younger) and ≥50 years (older), then by cold ischemic times of <120 min (short), 120 to 240 min (intermediate), and >240 min (long). Endpoints included recipient and graft survival, and freedom from cardiac allograft vasculopathy, nonfatal major adverse cardiac events, and rejection. For intermediate ischemic times, the 5-year recipient survival rate was lower when donors were older (70% vs 82.6%; =0.02). This was also true for long ischemic times (69.8% vs 87.6%;=0.09). For short ischemic times, we found no difference in 5-year recipient or graft survival rates (80% older vs 85.6% younger; =0.79), in freedom from nonfatal major adverse cardiac events (83.3% vs 91.5%;=0.46), or in freedom from cardiac allograft vasculopathy (50% vs 70.6%; =0.66). Rejection rates were mostly similar. Long-term graft survival in heart transplantation patients with older donor allografts may improve when cold ischemic times are shorter.

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“…Donor age, when analyzed, is consistently reported to be associated with CAV detection []. This concept is not novel and is mainly related to the risk of transmission of donor coronary lesions to the recipient, as also suggested by studies finding that male donors – more likely to bear subclinical coronary lesions – may be associated with CAV development .…”

Section: Discussionmentioning

confidence: 99%

Coronary artery disease in heart transplantation: new concepts for an old disease

et al. 2018

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Cardiac allograft vasculopathy (CAV) remains one of the main long-term complications after heart transplantation. We performed a systematic review focused on articles published in the previous 6 years to reappraise the novel evidences supporting risk factors, pathology, prevention, and treatment of CAV. We identified a search string for a literature search on PubMed. We excluded articles specifically focused on diagnosis/biomarkers/imaging only or complications of other diseases. We included 98 studies out of our search. Forty-eight articles describe risk factors for CAV, 13 pathology, 24 prevention, and 13 treatment for CAV. While confirming known concepts, we found supportive evidence that CAV pathophysiology may vary according to the time post-transplant and the prevalence of metabolic versus immune-mediated risk factors. Selective revascularization of focal lesions in patients with CAV may result in some clinical benefit, but CAV prevention, rather than treatment, by controlling risk factors and by using targeted immunosuppressive therapies is the most evidence-based approach to reduce disease progression.

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The policy of placing older donors into older recipients: is it worth the risk?

Abstract: Use of older donors (≥50 yr) in older recipients (≥60 yr) results in lower five-yr survival and freedom from CAV. Caution is required in these cases. Larger studies are warranted to confirm findings.

Cited by 9 publications

References 20 publications

Does donor‐recipient age difference matter in outcome of heart transplantation?

Does donor‐recipient age difference matter in outcome of heart transplantation?

Effects of Older Donor Age and Cold Ischemic Time on Long-Term Outcomes of Heart Transplantation

Coronary artery disease in heart transplantation: new concepts for an old disease

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