EXTENDED DONOR CRITERIA - HEMODYNAMIC FOLLOW-UP OF HEART-TRANSPLANT RECIPIENTS RECEIVING A CARDIAC ALLOGRAFT FROM DONORS GREATER-THAN-OR-EQUAL-TO-60 YEARS OF AGE

Background. Heart transplantation (HT) has become a therapeutic option for patients suffering from endstage heart failure. The increasing de mand for cardiac allografts has led to a shift toward extended donor c riteria, In a retrospective analysis of 859 HT recipients, we report o n the hemodynamic outcome of 19 HT patients who received cardiac allog rafts from donors greater than or equal to 60 years of age. Methods. F rom March 1989 to December 1997, we performed 883 orthotopic HT in 74 children and 809 adults at our transplant center, Within this period, 19 patients (17 women and 2 men) received cardiac allografts from dono rs greater than or equal to 60 years of age. Recipient age ranged from 57 to 78 years (mean, 65+/-5 years), Results. HT could be performed s uccessfully in 19 cases. The early mortality rate was 16% (n=3),Tbe la te mortality rate was 37% (n=7). All long-term survivors are stable at New York Heart Association classification II (New York Heart Associat ion Class II = resting hemodynamics: cardiac output normal; left ventr icular end diastolic filling pressure elevated; clinically not comprom ised during mild to moderate workout), Although only 19 patients were retrospectively evaluated, there was a statistically significant (P<0. 05) difference in survival among patients who received organs from mal e (11 vs. 8 dagger) compared with female (8 vs. 2 dagger) (dagger=deat h) donors. Conclusion. In our experience, it is possible to increase t he cardiac donor pool by accepting allografts from donors, preferably female, greater than or equal to 60 years of age in selected cases wit hout a coronary angiogram, if hemodynamic parameters are in a normal r ange on mild-to-moderate inotropic support, We do not recommend cardia c allografts from donors greater than or equal to 60 if there are sign s of coronary insufficiency in the electrocardiogram, if left ventricl e filling pressures are above normal on mild-to-moderate inotropic sup port and optimum hemodynamic management, or if there are signs of segm ental dysfunction or mitral insufficiency >I in the echocardiogram.