DONOR SHORTAGE IN HEART-TRANSPLANTATION

Chronic shortage of donor organs for heart transplantation led us to e xtend donor age limits. To verify the effectiveness of such a policy w e have compared the results of heart transplantation in 45 patients wi th donors more than 40 years of age (group 1),vith those of 72 patient s older than 50 years of age who had heart transplantation with younge r donors (group 2) between November 1985 and December 1992. The two gr oups were comparable in terms of mean recipient age, recipient and don or sex, and indication for heart transplantation. Mean donor age was 4 6 +/- 4 years (range 41 to 59 years) in group 1 and 23 +/- 7 years (ra nge 8 to 39 years) in group 2 (p < 0.001). In group 1 cerebrovascular accidents were more common as the cause of donor death (60% versus 16% , p = 0.001), and no difference was found in ischemic time (144 +/- 47 minutes versus 140 +/- 48 minutes, p = not significant). There were 6 early (<30 days) deaths in group 1 (13%) and 10 in group 2 (14%; p = not significant). Fatal acute graft failure was more prevalent, but no t significantly so, in group 1 (10% versus 5.5%, p = not significant). Mean follow-up was 29 +/- 20 months (range 3 to 78 months) in group 1 and 30 +/- 20 months (range 3 to 80 months) in group 2 (p = not signi ficant). At 5 years actuarial survival was 80% +/- 6% in both groups w ith comparable graft performance at echocardiographic and hemodynamic control studies. A significant difference was found in freedom from an y type of coronary artery abnormality between group 1 (49% +/- 13%) an d group 2 (77% +/- 8%) at 5 years (p < 0.05); however, freedom from co ronary stenotic lesions only was similar. Major conduction disturbance s have occurred more frequently in patients of group 1 (37% versus 12% ; p = 0.003) without any difference in the need for permanent pacing. Donors older than 40 years of age can be accepted for heart transplant ation with early and long-term results comparable with those obtained with younger donors. The impact of a higher incidence of coronary abno rmalities on late performance of older grafts must be assessed at long er follow-up. Our results indicate that, because of the current organ shortage, extension of donor age limits is justified, even up to the s ixth decade of life in selected cases.