Department of Surgery, Massachusetts General Hospital, Boston, MA, USA.
Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
Am J Transplant. 2019 Mar;19(3):876-883. doi: 10.1111/ajt.15073. Epub 2018 Sep 12.
Hearts from older donors are increasingly utilized for transplantation due to unmet demand. Conflicting evidence exists regarding the prognosis of recipients of advanced age donor hearts, especially in young recipients. A retrospective analysis was performed on 11 433 patients aged 18 to 45 who received a cardiac transplant from 2000 to 2017. Overall, 10 279 patients received hearts from donors less than 45 and 1145 from donors greater than 45. Recipients of older donors were older (37 vs. 34 years, P < .01) and had higher rates of inotropic dependence (48% vs. 42%, P < .01). However, groups were similar in terms of comorbidities and dependence on mechanical circulatory support. Median survival for recipients of older donors was reduced by 2.6 years (12.6 vs. 15.2, P < .01). Multivariable analysis demonstrated donor age greater than 45 to be a predictor of mortality (HR 1.18 [1.05-1.33], P = .01). However, when restricting the analysis to patients who received a donor with a negative preprocurement angiogram, donor age only had a borderline association with mortality (HR 1.20 [0.98-1.46], P = .06). Older donor hearts in young recipients are associated with decreased long-term survival, however this risk is reduced in donors without atherosclerosis. The long-term hazard of this practice should be carefully weighed against the risk of waitlist mortality.
由于供体需求未得到满足，越来越多的老年供体心脏被用于移植。关于高龄供体心脏受者的预后存在相互矛盾的证据，尤其是在年轻受者中。对 2000 年至 2017 年间接受心脏移植的 11433 名 18 至 45 岁的患者进行了回顾性分析。总体而言，10279 名患者接受了年龄小于 45 岁的供体心脏，1145 名患者接受了年龄大于 45 岁的供体心脏。老年供体心脏受者年龄更大（37 岁比 34 岁，P<.01），并且对正性肌力药物的依赖率更高（48%比 42%，P<.01）。然而，两组在合并症和对机械循环支持的依赖方面相似。老年供体心脏受者的中位生存期缩短了 2.6 年（12.6 年比 15.2 年，P<.01）。多变量分析表明，供体年龄大于 45 岁是死亡的预测因素（HR 1.18 [1.05-1.33]，P=.01）。然而，当将分析限制在接受供体术前血管造影呈阴性的患者时，供体年龄仅与死亡率有边缘相关性（HR 1.20 [0.98-1.46]，P=.06）。年轻受者接受老年供体心脏与长期生存率降低相关，但在无动脉粥样硬化的供体中，这种风险降低。这种做法的长期风险应仔细权衡等待名单死亡率的风险。
