CHANGING PATTERNS IN DONOR AND RECIPIENT RISK - A 10-YEAR EVOLUTION IN ONE HEART-TRANSPLANT CENTER

Background: Expansion of the donor pool and liberalization of recipien t criteria have occurred since the introduction of cyclosporine for he art transplantation. Methods: We sought to evaluate the impact of thes e changes on outcome during a 10-year period in one program. A total o f 251 transplantations were retrospectively reviewed and divided into two periods (1984 to 1989 and 1990 to 1994). Results: In the latter pe riod, there were increases in donor and recipient age, degree of weigh t mismatch, ischemic time, bypass time, and severity of illness in the recipient before transplantation as judged by status at the time of t ransplantation and preoperative requirements for pharmacologic or mech anical support. Despite these changes, time to hospital discharge decr eased and a trend to improved survival was seen with the use of Kaplan -Meier analysis. Conclusions: These findings suggest that improvements in perioperative and posttransplantation care have permitted a safe e xpansion of both the donor pool and recipient criteria for transplanta tion.