Dc. Drinkwater et al., OUTCOMES OF PATIENTS UNDERGOING TRANSPLANTATION WITH OLDER DONOR HEARTS, The Journal of heart and lung transplantation, 15(7), 1996, pp. 684-691
Background: The limited number of donor hearts relative to the number
of waiting recipients is the major determinate of a growing inequity.
Although a number of potential options are being vigorously pursued, t
he most effective immediate solution is to expand acceptance criteria
for donor age and medical condition. This report is a review of our ea
rly and late results with the use of older donors, including simultane
ously ''bypassed'' donor hearts. Methods: Between April 1987 and Septe
mber 1994, 52 patients received older donor hearts (older than 45 year
s) with a mean donor age of 51 years. Ten patients in this group recei
ved hearts simultaneously bypassed with from 1 to 4 grafts per patient
. Donor and recipient age, diagnosis, and HLA match were compared betw
een the older donor group and a contemporaneous younger (younger than
45) donor group (N = 324). Also compared was actuarial survival at up
to 5 years of follow-up in addition to graft function, bypass graft pa
tency, infection and rejection incidence at 1 year, and the prevalence
of transplant-associated coronary artery disease in the two groups. E
chocardiography, coronary angiography, and intravascular coronary ultr
asonography were used for this assessment. Results: One-year actuarial
survival was 84% for the older donor group, which included 19 status
1 patients (survival 76%) and 23 status II patients (survival 90%). In
the bypassed donor subgroup there was a 60% 1-year actuarial survival
with 5 status 1 patients (survival 80%) and 5 status II patients (sur
vival 40%). At 1 year, left ventricular function and the incidence of
infection and rejection were equal between these two donor groups. Fiv
e-year actuarial survivals were the same between the overall older and
younger donor groups. Finally, the development of transplant-associat
ed coronary disease was similar in both groups up to 5 years after tra
nsplantation. Conclusions: This initial review of heart transplantatio
n with older donor hearts, including bypassed hearts, demonstrates sim
ilar early and late survival outcomes as compared with those of a cont
emporaneous younger donor group. Significantly, there appears to be no
difference in the development of transplant-associated coronary arter
y disease during the follow-up period. The older donor represents a po
tential immediate increase in the number of suitable hearts for transp
lantation. Bypassed donor hearts represent a small but potentially sig
nificant subgroup that may be safely and effectively used when appropr
iately matched to the recipient by age and medical condition. Greater
experience, particularly with this bypassed group, will help determine
optimal donor-to-recipient matching for the future.